Healthcare Provider Details

I. General information

NPI: 1639880347
Provider Name (Legal Business Name): JESUS PROVIDES OUR DAILY BREAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 FAIR STREET JESUS CENTER
CHICO CA
95928-9592
US

IV. Provider business mailing address

2255 FAIR ST
CHICO CA
95928-6747
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-2640
  • Fax: 530-345-2449
Mailing address:
  • Phone: 530-345-2640
  • Fax: 530-345-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: AMBER R ABNEY-BASS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-345-2640