Healthcare Provider Details

I. General information

NPI: 1518997949
Provider Name (Legal Business Name): JRJS HEALTHCARE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 RETAMA CIR
VICTORIA TX
77901-2765
US

IV. Provider business mailing address

4208 RETAMA CIR
VICTORIA TX
77901-2765
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-4493
  • Fax: 361-582-4043
Mailing address:
  • Phone: 361-582-4493
  • Fax: 361-582-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number652510000
License Number StateTX

VIII. Authorized Official

Name: MRS. TAMMY L BELL
Title or Position: CORPORATE FINANCIAL MANAGER
Credential:
Phone: 361-582-0602