Provider Demographics
NPI:1528488962
Name:JBRACEWELL ENTERPRISES, LLC
Entity type:Organization
Organization Name:JBRACEWELL ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-391-0000
Mailing Address - Street 1:115 WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4339
Mailing Address - Country:US
Mailing Address - Phone:636-391-0000
Mailing Address - Fax:636-391-0005
Practice Address - Street 1:115 WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4339
Practice Address - Country:US
Practice Address - Phone:636-391-0000
Practice Address - Fax:636-391-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health