MEDICARE: JOURDANTON HOME CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	012459	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH9806	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003899485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURDANTON HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	1907 E STATE HIGHWAY 97 STE 230
Second Line	:
City	:	JOURDANTON
State	:	TX
Zip	:	78026-1534
Country	:	US
Telephone Number	:	830-281-8136
Fax Number	:	830-281-8751

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSHUA L. PROFFITT
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	10/04/2024

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