Provider Demographics
NPI:1538426705
Name:JIM HOGG CO. NUTRITION PROGRAM
Entity type:Organization
Organization Name:JIM HOGG CO. NUTRITION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEGOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-527-5835
Mailing Address - Street 1:209 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:HEBBRONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78361-3517
Mailing Address - Country:US
Mailing Address - Phone:361-527-5835
Mailing Address - Fax:361-527-2913
Practice Address - Street 1:209 N OAK ST
Practice Address - Street 2:
Practice Address - City:HEBBRONVILLE
Practice Address - State:TX
Practice Address - Zip Code:78361-3517
Practice Address - Country:US
Practice Address - Phone:361-527-5835
Practice Address - Fax:361-527-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals