Provider Demographics
NPI:1093557910
Name:JACKETS CONTRACTORS & ASSOCIATES LLC
Entity type:Organization
Organization Name:JACKETS CONTRACTORS & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QANTASIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-400-5954
Mailing Address - Street 1:3740 HOLTON CIR APT 3301
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-8409
Mailing Address - Country:US
Mailing Address - Phone:512-400-5954
Mailing Address - Fax:
Practice Address - Street 1:104 DIXON AVE
Practice Address - Street 2:DIXON AVE
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785
Practice Address - Country:US
Practice Address - Phone:512-400-5954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No251E00000XAgenciesHome Health