Provider Demographics
NPI:1134820095
Name:JIREH THERAPEUTICS LLC
Entity type:Organization
Organization Name:JIREH THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:KORLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:601-624-5912
Mailing Address - Street 1:5471 RIVER THAMES PLACE
Mailing Address - Street 2:
Mailing Address - City:JACKSN
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-566-5007
Mailing Address - Fax:
Practice Address - Street 1:5471 RIVER THAMES PLACE
Practice Address - Street 2:
Practice Address - City:JACKSN
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-566-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIREH THERAPEUTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty