=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205135266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J MASTERS HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2011
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5963 SOUTHGOOD ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77033-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-643-5370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5963 SOUTHGOOD ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77033-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-643-5370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | JOHN MASTER JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-643-5370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | 04978850
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------