MEDICARE: JADE DKR 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

General Provider Information

NPI Number	:	1073079539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JADE DKR LLC

Provider Business Mailing Address
First Line	:	239 BELMONT # B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-3012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 NW LOOP 410 STE B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5105
Country	:	US
Telephone Number	:	210-521-1244
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLEY WINN
Credential	:
Telephone Number	:	210-385-9500

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/02/2022

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