Provider Demographics
NPI:1366101115
Name:JDM HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:JDM HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANYOSO
Authorized Official - Last Name:MWONGA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE, MS
Authorized Official - Phone:817-808-3533
Mailing Address - Street 1:1118 CAVALCADE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7126
Mailing Address - Country:US
Mailing Address - Phone:817-896-1587
Mailing Address - Fax:469-520-5801
Practice Address - Street 1:1118 CAVALCADE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7126
Practice Address - Country:US
Practice Address - Phone:817-808-3533
Practice Address - Fax:469-520-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health