Provider Demographics
NPI:1447876024
Name:JABEZ COMMUNITY RESOURCE CENTER
Entity type:Organization
Organization Name:JABEZ COMMUNITY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAHMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:870-636-3985
Mailing Address - Street 1:2910 DICKSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3638
Mailing Address - Country:US
Mailing Address - Phone:870-636-3985
Mailing Address - Fax:
Practice Address - Street 1:2910 DICKSON ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3638
Practice Address - Country:US
Practice Address - Phone:870-636-3985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health