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General NPI Number Information
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NPI Number | 1225583339
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Entity Type | Organization
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Legal Business Name | SJ HOME CARE
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 1605 JUDSON RD SUITE B-F
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City | LONGVIEW
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State | TX
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Zip | 75601-3662
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Country | US
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Telephone | 903-215-8183
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Fax | 903-215-8184
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Provider Business Mailing Address
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Address Line | 401 E FRONT ST SUITE 245
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City | TYLER
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State | TX
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Zip | 75702-8213
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Country | US
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Telephone | 903-581-5122
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Fax | 903-215-8184
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Authorized Official
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Title or Position | ALTERNATE ADMINISTRATOR
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Name | MS. JACKIE BRISSET
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Credential | HCC, MC
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Telephone | 903-215-8183
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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 | 014739
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License Number State | TX
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