Healthcare Provider Details

I. General information

NPI: 1700886694
Provider Name (Legal Business Name): JRJS HEALTHCARE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N DE LEON ST
VICTORIA TX
77901-5902
US

IV. Provider business mailing address

1501 N DE LEON ST
VICTORIA TX
77901-5902
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-0602
  • Fax: 361-582-0509
Mailing address:
  • Phone: 361-582-0602
  • Fax: 361-582-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number005346
License Number StateTX

VIII. Authorized Official

Name: MR. RICHARD LEGGETT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 361-582-0602