=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164947628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JCL HEINTZ CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2017
-----------------------------------------------------
Last Update Date | 08/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9538 HUFFMEISTER RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-924-3160
-----------------------------------------------------
Fax | 832-924-8899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9538 HUFFMEISTER RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-924-3160
-----------------------------------------------------
Fax | 832-924-8899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | SANDRA HEINTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-924-3160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 015811
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------