Provider Demographics
NPI:1801237375
Name:JIREH SERVICES,LLC
Entity type:Organization
Organization Name:JIREH SERVICES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARONDA
Authorized Official - Middle Name:TERASSA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-529-6700
Mailing Address - Street 1:PO BOX 170431
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-0027
Mailing Address - Country:US
Mailing Address - Phone:864-541-7496
Mailing Address - Fax:
Practice Address - Street 1:180 JOHN B. WHITE SR. BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306
Practice Address - Country:US
Practice Address - Phone:864-541-7496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC906111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty