=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790292308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BJ & M HEALTHCARE SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2018
-----------------------------------------------------
Last Update Date | 11/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 1 H 10 NORTH
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-835-4703
-----------------------------------------------------
Fax | 832-919-9029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3415 HORNBEAM DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-835-4703
-----------------------------------------------------
Fax | 832-919-9029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CHIDUBEM CHIWUZIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-835-4703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------