Healthcare Provider Details

I. General information

NPI: 1053602367
Provider Name (Legal Business Name): JABEZ EMPOWERMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 STATELINE ROAD SUITE 4
OAK GROVE KY
42262
US

IV. Provider business mailing address

375 DOVER RD STE B
CLARKSVILLE TN
37042-4144
US

V. Phone/Fax

Practice location:
  • Phone: 931-906-3993
  • Fax: 931-503-0472
Mailing address:
  • Phone: 931-906-3993
  • Fax: 931-503-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL CLARDY STEVENS
Title or Position: PRESIDENT
Credential:
Phone: 931-906-3993