Provider Demographics
NPI:1720215494
Name:HOBLACKJONES INCORPORATED
Entity Type:Organization
Organization Name:HOBLACKJONES INCORPORATED
Other - Org Name:BRIGHTSTAR OF STROUDSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, MSN/MBA
Authorized Official - Phone:570-223-2248
Mailing Address - Street 1:6258 ROUTE 209
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7159
Mailing Address - Country:US
Mailing Address - Phone:570-223-2248
Mailing Address - Fax:
Practice Address - Street 1:6258 ROUTE 209
Practice Address - Street 2:SUITE 2
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7159
Practice Address - Country:US
Practice Address - Phone:570-223-2248
Practice Address - Fax:570-231-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN326286L251E00000X
PA04730501251E00000X, 251J00000X
PA14273601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023866020001OtherPENSYLVANIA WAIVER PROVIDER - LOCATION 0001 - MPI NUMBER
PA10236602002OtherPENSYLVANIA WAIVER PROVIDER - LOCATION 0002 - MPI NUMBER
PA1023866020003OtherPENSYLVANIA WAIVER PROVIDER - LOCATION 0003 - MPI NUMBER