Provider Demographics
NPI:1740854975
Name:INDEPENDENT JOBS 1, LLC
Entity type:Organization
Organization Name:INDEPENDENT JOBS 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAIWANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CERTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-347-2928
Mailing Address - Street 1:713 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-4903
Mailing Address - Country:US
Mailing Address - Phone:601-347-2928
Mailing Address - Fax:
Practice Address - Street 1:713 CHARLOTTE DR
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-4903
Practice Address - Country:US
Practice Address - Phone:601-347-2928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility