MEDICARE: LJNP FAMILY HOLDINGS LLC - SERIES SH4867

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1023954286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LJNP FAMILY HOLDINGS LLC - SERIES SH4867

Provider Business Mailing Address
First Line	:	400 STONEBROOK PKWY STE 802
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-1179
Country	:	US
Telephone Number	:	972-357-9311
Fax Number	:	972-357-9312

Provider Business Practice Location Address
First Line	:	400 STONEBROOK PKWY STE 802
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-1179
Country	:	US
Telephone Number	:	972-357-9311
Fax Number	:	972-357-9312

Authorized Official
Title or Position	:	OWNER
Name	:	JINCY JOHN
Credential	:	OTR
Telephone Number	:	267-879-5973

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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