MEDICARE: J AND V COMFORT 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
1	253Z00000X	In Home Supportive Care Agency	018890	TX

General Provider Information

NPI Number	:	1578045308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J AND V COMFORT CARE LLC

Provider Business Mailing Address
First Line	:	12711 AUTUMN GLEN DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-7362
Country	:	US
Telephone Number	:	240-505-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	12711 AUTUMN GLEN DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-7362
Country	:	US
Telephone Number	:	240-505-7176
Fax Number	:

Authorized Official
Title or Position	:	ALTERNATE ADMINISTRATOR
Name	:	MR. JEREMIAH FANYUI
Credential	:
Telephone Number	:	240-505-7176

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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