Provider Demographics
NPI:1588154579
Name:JLM DELESANDRI LLC
Entity type:Organization
Organization Name:JLM DELESANDRI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DELESANDRI
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-705-9562
Mailing Address - Street 1:6400 BRADLEY AVE STE J
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117-4817
Mailing Address - Country:US
Mailing Address - Phone:817-585-1772
Mailing Address - Fax:817-585-1508
Practice Address - Street 1:6400 BRADLEY AVE STE J
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-4817
Practice Address - Country:US
Practice Address - Phone:817-585-1772
Practice Address - Fax:817-585-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies