Provider Demographics
NPI:1306303474
Name:JUMPSTART PLUS LLC
Entity type:Organization
Organization Name:JUMPSTART PLUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-369-8628
Mailing Address - Street 1:908 W EDINBURG AVE
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-1769
Mailing Address - Country:US
Mailing Address - Phone:956-369-8628
Mailing Address - Fax:202-640-4357
Practice Address - Street 1:908 W EDINBURG AVE
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1769
Practice Address - Country:US
Practice Address - Phone:956-369-8628
Practice Address - Fax:202-640-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine