Provider Demographics
NPI:1255734042
Name:JACOBS LADDER
Entity type:Organization
Organization Name:JACOBS LADDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:219-764-4888
Mailing Address - Street 1:7105 W. 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303
Mailing Address - Country:US
Mailing Address - Phone:219-916-3668
Mailing Address - Fax:
Practice Address - Street 1:322 W. 806N
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:219-764-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002230A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency