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General NPI Number Information
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NPI Number | 1124716238
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Entity Type | Organization
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Legal Business Name | JB AT-HOME CARE LLC
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 19850 HAVEN CLIFF LN
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City | CYPRESS
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State | TX
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Zip | 77433-4726
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Country | US
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Telephone | 346-218-3594
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Fax |
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Provider Business Mailing Address
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Address Line | 19850 HAVEN CLIFF LN
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City | CYPRESS
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State | TX
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Zip | 77433-4726
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Country | US
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Telephone | 346-218-3594
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | JONATHAN BETANCOURT
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Credential |
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Telephone | 346-218-3594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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