Provider Demographics
NPI:1164185039
Name:JBO,INC
Entity Type:Organization
Organization Name:JBO,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER/CARE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANETTA
Authorized Official - Middle Name:ROSLYN
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:FOUNDER/CEO
Authorized Official - Phone:704-309-7687
Mailing Address - Street 1:1425 LUTHER ST APT 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3492
Mailing Address - Country:US
Mailing Address - Phone:704-309-7687
Mailing Address - Fax:
Practice Address - Street 1:1425 LUTHER ST APT 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3492
Practice Address - Country:US
Practice Address - Phone:704-309-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JBO, MINISTRIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management