Provider Demographics
NPI:1992357123
Name:JAST HOME LLC
Entity type:Organization
Organization Name:JAST HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:LOBBAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:954-274-5934
Mailing Address - Street 1:1841 NW 125TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2552
Mailing Address - Country:US
Mailing Address - Phone:954-274-5934
Mailing Address - Fax:
Practice Address - Street 1:6071 NW 198TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4857
Practice Address - Country:US
Practice Address - Phone:954-274-5934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities