Provider Demographics
NPI:1376088435
Name:JAE LLC
Entity Type:Organization
Organization Name:JAE LLC
Other - Org Name:THE HAPPY MAMA PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOULA/LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:570-299-9247
Mailing Address - Street 1:827 STOCKTON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER MEADOWS
Mailing Address - State:PA
Mailing Address - Zip Code:18216-6505
Mailing Address - Country:US
Mailing Address - Phone:570-299-9246
Mailing Address - Fax:
Practice Address - Street 1:512 NORTHHAMPTON STREET
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-212-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006829225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty