Provider Demographics
NPI:1972373017
Name:TYLER COMMUNITY HOME CARE, LLC
Entity type:Organization
Organization Name:TYLER COMMUNITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-330-9625
Mailing Address - Street 1:1910 ESE LOOP323 # 220
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8337
Mailing Address - Country:US
Mailing Address - Phone:903-871-5093
Mailing Address - Fax:
Practice Address - Street 1:11930 GILLIAN COURT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-871-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty