MEDICARE: JONES BOARD AND 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	310400000X	Assisted Living Facility	000885	TX

General Provider Information

NPI Number	:	1568657849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONES BOARD AND CARE

Provider Business Mailing Address
First Line	:	2826 MARYLAND AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-4314
Country	:	US
Telephone Number	:	217-371-6881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 MARYLAND AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-4314
Country	:	US
Telephone Number	:	214-371-6881
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WYOMIA JONES
Credential	:
Telephone Number	:	214-371-6881

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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