Provider Demographics
NPI:1205142676
Name:JIREH NURSING AGENCY LLC
Entity type:Organization
Organization Name:JIREH NURSING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-659-1097
Mailing Address - Street 1:359 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2621
Mailing Address - Country:US
Mailing Address - Phone:215-659-1097
Mailing Address - Fax:215-659-1097
Practice Address - Street 1:359 YORK RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2621
Practice Address - Country:US
Practice Address - Phone:215-659-1097
Practice Address - Fax:215-659-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10-16-343251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health