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General NPI Number Information
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NPI Number | 1871863993
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Entity Type | Organization
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Legal Business Name | J R ROUNTREE ENTERPRISES, INC.
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 304 STONE MOUNTAIN DR
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City | SUNNYVALE
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State | TX
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Zip | 75182-2640
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Country | US
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Telephone | 214-783-8368
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 RINCON WAY
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City | DALLAS
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State | TX
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Zip | 75214-2038
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Country | US
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Telephone | 214-783-8368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. JEFFREY RYAN ROUNTREE
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Credential |
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Telephone | 214-783-8368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | TX
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