MEDICARE: JOVALDE INC

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

General Provider Information

NPI Number	:	1053601997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOVALDE INC

Provider Business Mailing Address
First Line	:	4922 STILL CRK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3527
Country	:	US
Telephone Number	:	210-421-1836
Fax Number	:	210-233-1350

Provider Business Practice Location Address
First Line	:	4922 STILL CRK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3527
Country	:	US
Telephone Number	:	210-421-1836
Fax Number	:	210-233-1350

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. VANESSA RUSSELL
Credential	:
Telephone Number	:	210-421-1836

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	06/17/2011

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Directions to “JOVALDE INC ” Practice Location

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