Provider Demographics
NPI:1912367020
Name:JABEL'S PLACE
Entity Type:Organization
Organization Name:JABEL'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAMPATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:778-378-4901
Mailing Address - Street 1:11805 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-8392
Mailing Address - Country:US
Mailing Address - Phone:775-378-4901
Mailing Address - Fax:
Practice Address - Street 1:11805 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-8392
Practice Address - Country:US
Practice Address - Phone:775-378-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005049893Medicaid