Healthcare Provider Details

I. General information

NPI: 1083217244
Provider Name (Legal Business Name): JAZMYN K HOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W GRAND RIVER AVE
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

5181 W MOUNTAIN ST UNIT 504
STONE MOUNTAIN GA
30086-0357
US

V. Phone/Fax

Practice location:
  • Phone: 520-541-6541
  • Fax:
Mailing address:
  • Phone: 520-257-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: