Provider Demographics
NPI:1346451366
Name:JESUS IS LORD HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:JESUS IS LORD HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-790-0767
Mailing Address - Street 1:2764 TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-7014
Mailing Address - Country:US
Mailing Address - Phone:706-790-5836
Mailing Address - Fax:706-790-0767
Practice Address - Street 1:2764 TOBACCO RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-7014
Practice Address - Country:US
Practice Address - Phone:706-790-5836
Practice Address - Fax:706-790-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021-R-0019251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000804889BMedicaid
GA000804889HMedicaid
GA000804889CMedicaid
GA000804889GMedicaid
GA000804889KMedicaid
GA000804889DMedicaid
GA000804889AMedicaid