Provider Demographics
NPI:1659806701
Name:JESSE HEALTHCARE CORPERATION
Entity Type:Organization
Organization Name:JESSE HEALTHCARE CORPERATION
Other - Org Name:JESSE HEALTHCARE CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CARE MANAGEGER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:ROLI
Authorized Official - Last Name:ULOGHOBUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-445-8624
Mailing Address - Street 1:1477 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-3253
Mailing Address - Country:US
Mailing Address - Phone:847-445-8624
Mailing Address - Fax:757-965-3410
Practice Address - Street 1:1477 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3253
Practice Address - Country:US
Practice Address - Phone:847-445-8624
Practice Address - Fax:757-965-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management