Provider Demographics
NPI:1487918892
Name:JIREH LIVING ASSISTANCE SERVICE LLC
Entity type:Organization
Organization Name:JIREH LIVING ASSISTANCE SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIGDALIA
Authorized Official - Middle Name:ITZEL
Authorized Official - Last Name:OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-827-2675
Mailing Address - Street 1:PO BOX 8165
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-8165
Mailing Address - Country:US
Mailing Address - Phone:281-827-2675
Mailing Address - Fax:713-583-2003
Practice Address - Street 1:3215 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:281-827-2675
Practice Address - Fax:713-583-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TXNA08637069253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3239352Medicaid