Healthcare Provider Details

I. General information

NPI: 1114087467
Provider Name (Legal Business Name): KELLI JONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 NOB HL
WOLFE CITY TX
75496-3007
US

IV. Provider business mailing address

887 NOB HL
WOLFE CITY TX
75496-3007
US

V. Phone/Fax

Practice location:
  • Phone: 903-496-9255
  • Fax:
Mailing address:
  • Phone: 903-496-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLI LEANN JONES
Title or Position: SOLE PROPRIETOR,OWNER
Credential:
Phone: 903-496-9255