Provider Demographics
NPI:1871916221
Name:J & C HOMECARE AGENCY
Entity type:Organization
Organization Name:J & C HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-757-0921
Mailing Address - Street 1:1700 E PIONEER PKWY STE 188
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6612
Mailing Address - Country:US
Mailing Address - Phone:619-757-0921
Mailing Address - Fax:
Practice Address - Street 1:1700 E PIONEER PKWY STE 188
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6612
Practice Address - Country:US
Practice Address - Phone:619-757-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014956253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014956OtherTEXAS DEPT. OF AGING AND DISABILITY SERVICES