Provider Demographics
NPI:1871686931
Name:JLG HEALTH GROUP, LLC
Entity type:Organization
Organization Name:JLG HEALTH GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:956-857-5900
Mailing Address - Street 1:3301 E FROST ST
Mailing Address - Street 2:N/A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-1528
Mailing Address - Country:US
Mailing Address - Phone:956-857-5900
Mailing Address - Fax:956-718-2354
Practice Address - Street 1:3301 E FROST ST
Practice Address - Street 2:N/A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-1528
Practice Address - Country:US
Practice Address - Phone:956-857-5900
Practice Address - Fax:956-718-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009968251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679506Medicare ID - Type UnspecifiedPROVIDER NUMBER
679506Medicare Oscar/Certification