=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093350399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JABA CONSULTANTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2019
-----------------------------------------------------
Last Update Date | 01/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 PRIMERA BLVD STE 125
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-406-2002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 PRIMERA BLVD STE 125
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-406-2002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER BRENNAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-406-2002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------