Provider Demographics
NPI:1023209855
Name:JABEZ HOME INFUSION COMPANY
Entity Type:Organization
Organization Name:JABEZ HOME INFUSION COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:PATTEN
Authorized Official - Last Name:COWART
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:252-758-9304
Mailing Address - Street 1:2495 HEMBY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3771
Mailing Address - Country:US
Mailing Address - Phone:252-758-9304
Mailing Address - Fax:252-758-6904
Practice Address - Street 1:2495 HEMBY LN
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3771
Practice Address - Country:US
Practice Address - Phone:252-758-9304
Practice Address - Fax:252-758-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08132332B00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046JWOtherBCBSNC
NC046JVOtherBCBSNC
NC6800458Medicaid
NC007CMOtherBCBSNC
NC0745929Medicaid
NC7703685Medicaid
NC046JWOtherBCBSNC