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NPI Code Detail

MEDICARE: JBK HOUSE OF CARE LLC

MEDICARE: JBK HOUSE OF CARE 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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1518573609
Entity Type Code : Organization
Provider Name (Legal Business Name) : JBK HOUSE OF CARE LLC
Provider Business Mailing Address
First Line : 2624 GRAND GULF RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-2613
Country : US
Telephone Number : 817-323-3591
Fax Number :
Provider Business Practice Location Address
First Line : 2624 GRAND GULF RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-2613
Country : US
Telephone Number : 817-323-3591
Fax Number :
Authorized Official
Title or Position : PROGRAM MANAGER
Name : ESTHER CARINE KALOMBO
Credential :
Telephone Number : 817-323-3591
Provider Enumeration Date : 09/23/2020
Last Update Date : 09/23/2020

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Directions to “JBK HOUSE OF CARE LLC ” Practice Location

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