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General NPI Number Information
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NPI Number | 1851550594
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Entity Type | Organization
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Legal Business Name | JOD HOME HEALTH CARE SERVICE LLC
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Dates
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Enumeration Date | 06/07/2008
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Last Update Date | 06/07/2008
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Provider Practice Location Address
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Address Line | 1506 WHITE WILLOW LN
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City | ARLINGTON
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State | TX
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Zip | 76002-4624
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Country | US
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Telephone | 817-784-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 WHITE WILLOW LN
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City | ARLINGTON
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State | TX
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Zip | 76002-4624
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Country | US
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Telephone | 817-784-6252
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR.
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Name | MR. OLUWAROTIMI OLANREWAJU ODUBANJO
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Credential |
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Telephone | 817-784-6252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | RN LIC. NO 753086
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License Number State | TX
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