Provider Demographics
NPI:1437356417
Name:JABEZ VILLAGE, INC
Entity Type:Organization
Organization Name:JABEZ VILLAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-682-6803
Mailing Address - Street 1:1019 GULF ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1408
Mailing Address - Country:US
Mailing Address - Phone:417-682-6803
Mailing Address - Fax:417-682-6804
Practice Address - Street 1:1019 GULF ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1408
Practice Address - Country:US
Practice Address - Phone:417-682-6803
Practice Address - Fax:417-682-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services