=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396049037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J & J HOME HEALTH AGENCY INC.,
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2011
-----------------------------------------------------
Last Update Date | 04/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 ST LOUIS AVE. SUITE 200
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-4004
-----------------------------------------------------
Fax | 817-332-4224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2716 COUNTY ROAD 804A
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-447-8426
-----------------------------------------------------
Fax | 817-447-9958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JASON PAUL MOSES
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 871-447-8426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 006536
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------