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General NPI Number Information
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NPI Number | 1922425511
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Entity Type | Organization
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Legal Business Name | G J & K LEGACY ENTERPRISES, INC
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 12302 CARMEL DALE LN
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City | HOUSTON
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State | TX
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Zip | 77089-5719
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Country | US
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Telephone | 832-871-2105
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 57697
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 832-871-2105
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Fax |
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Authorized Official
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Title or Position | ALT ADMINISTRATOR, BUSINESS MANAGER
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Name | MRS. GLADYS FAYE HOLMES
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Credential | RN
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Telephone | 281-795-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 668536
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License Number State | TX
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