Provider Demographics
NPI:1609465541
Name:WHITES EXECUTIVE PATIENT HOME CARE LLC
Entity type:Organization
Organization Name:WHITES EXECUTIVE PATIENT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKIYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-600-4081
Mailing Address - Street 1:1220 RIVER BEND DR STE 116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4996
Mailing Address - Country:US
Mailing Address - Phone:214-600-4081
Mailing Address - Fax:866-224-2441
Practice Address - Street 1:1220 RIVER BEND DR STE 116
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4996
Practice Address - Country:US
Practice Address - Phone:214-600-4081
Practice Address - Fax:866-224-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty