Provider Demographics
NPI:1215210075
Name:FAMILY ARK, INC.
Entity Type:Organization
Organization Name:FAMILY ARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-288-6800
Mailing Address - Street 1:101 NOAHS ARK
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5373
Mailing Address - Country:US
Mailing Address - Phone:812-282-8479
Mailing Address - Fax:812-282-8636
Practice Address - Street 1:215 RAINBOW WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5374
Practice Address - Country:US
Practice Address - Phone:812-282-8479
Practice Address - Fax:812-282-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN169063933 50084253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency