Provider Demographics
NPI:1881199388
Name:JACOB'S HOME CARE LLC
Entity Type:Organization
Organization Name:JACOB'S HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-844-8635
Mailing Address - Street 1:2343 N DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4112
Mailing Address - Country:US
Mailing Address - Phone:417-351-5308
Mailing Address - Fax:417-350-1489
Practice Address - Street 1:2343 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4112
Practice Address - Country:US
Practice Address - Phone:417-351-5308
Practice Address - Fax:417-350-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care