Provider Demographics
NPI:1790121721
Name:IN GOD'S HANDS TRANSITIONAL LIVING HOME, INC.
Entity Type:Organization
Organization Name:IN GOD'S HANDS TRANSITIONAL LIVING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YE JUANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-949-7758
Mailing Address - Street 1:1032 MULLINS
Mailing Address - Street 2:24
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3380
Mailing Address - Country:US
Mailing Address - Phone:870-949-7758
Mailing Address - Fax:
Practice Address - Street 1:1032 MULLINS
Practice Address - Street 2:24
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3380
Practice Address - Country:US
Practice Address - Phone:870-949-7758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196258763Medicaid
AR196133746Medicaid