Provider Demographics
NPI:1023628500
Name:KHYJAYNOE CARES LLC
Entity type:Organization
Organization Name:KHYJAYNOE CARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-306-3845
Mailing Address - Street 1:4611 E HOUSTON ST APT 3004
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1768
Mailing Address - Country:US
Mailing Address - Phone:414-306-3845
Mailing Address - Fax:
Practice Address - Street 1:4611 E HOUSTON ST APT 3004
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-1768
Practice Address - Country:US
Practice Address - Phone:414-306-3845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No332U00000XSuppliersHome Delivered Meals