Provider Demographics
NPI:1639310410
Name:JABEZ MANAGEMENT
Entity Type:Organization
Organization Name:JABEZ MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:RENE'E
Authorized Official - Last Name:SELLARS-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-349-7676
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-1404
Mailing Address - Country:US
Mailing Address - Phone:336-349-7676
Mailing Address - Fax:
Practice Address - Street 1:122 N MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-2902
Practice Address - Country:US
Practice Address - Phone:336-349-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-079-099322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children