MEDICARE: JERNIGAN'S ADULT DAY CARE

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1508305848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERNIGAN'S ADULT DAY CARE

Provider Business Mailing Address
First Line	:	5039 REED RD
Second Line	:	SUITE 1
City	:	HOUSTON
State	:	TX
Zip	:	77033-4000
Country	:	US
Telephone Number	:	832-683-0278
Fax Number	:	832-804-7421

Provider Business Practice Location Address
First Line	:	5039 REED RD
Second Line	:	SUITE 1
City	:	HOUSTON
State	:	TX
Zip	:	77033-4000
Country	:	US
Telephone Number	:	832-683-0278
Fax Number	:	832-804-7421

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VERONICA EVETTE JERNIGAN
Credential	:
Telephone Number	:	832-683-0278

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	02/20/2017

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