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General NPI Number Information
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NPI Number | 1487918892
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Entity Type | Organization
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Legal Business Name | JIREH LIVING ASSISTANCE SERVICE LLC
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 3215 PRESTON AVE
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City | PASADENA
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State | TX
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Zip | 77505
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Country | US
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Telephone | 281-827-2675
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Fax | 713-583-2003
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Provider Business Mailing Address
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Address Line | PO BOX 8165
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City | PASADENA
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State | TX
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Zip | 77508-8165
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Country | US
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Telephone | 281-827-2675
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Fax | 713-583-2003
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MIGDALIA ITZEL OLMOS
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Credential |
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Telephone | 281-827-2675
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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 | NA08637069
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License Number State | TX
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