Provider Demographics
NPI:1225682347
Name:JACOB'S HEART CHILDREN'S CANCER SUPPORT SERVICES
Entity Type:Organization
Organization Name:JACOB'S HEART CHILDREN'S CANCER SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUTTERWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-724-9100
Mailing Address - Street 1:680 W BEACH ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-5140
Mailing Address - Country:US
Mailing Address - Phone:831-724-9100
Mailing Address - Fax:
Practice Address - Street 1:680 W BEACH ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-5140
Practice Address - Country:US
Practice Address - Phone:831-724-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle