Provider Demographics
NPI:1376688028
Name:THE JABEZ HOUSE, LLC
Entity Type:Organization
Organization Name:THE JABEZ HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAVINA
Authorized Official - Last Name:SEABROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-273-1987
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-0324
Mailing Address - Country:US
Mailing Address - Phone:336-273-1987
Mailing Address - Fax:336-273-1988
Practice Address - Street 1:1314 E CONE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4532
Practice Address - Country:US
Practice Address - Phone:336-273-1987
Practice Address - Fax:336-273-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-715322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603734Medicaid