Provider Demographics
NPI:1275849390
Name:JEANNETTE ABNEY
Entity Type:Organization
Organization Name:JEANNETTE ABNEY
Other - Org Name:JIREH PROVISIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-536-2277
Mailing Address - Street 1:304 S MAPLE ST SE
Mailing Address - Street 2:D
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8947
Mailing Address - Country:US
Mailing Address - Phone:616-536-2277
Mailing Address - Fax:
Practice Address - Street 1:4000 ALPINE AVE NW
Practice Address - Street 2:577
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8033
Practice Address - Country:US
Practice Address - Phone:313-720-6791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No282NW0100XHospitalsGeneral Acute Care HospitalWomenGroup - Multi-Specialty