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General NPI Number Information
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NPI Number | 1164765665
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Entity Type | Organization
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Legal Business Name | JABEZ'S DREAM
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 619 W. 37TH STREET
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City | SAVANNAH
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State | GA
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Zip | 31415
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Country | US
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Telephone | 912-335-2508
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Fax | 912-335-2543
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Provider Business Mailing Address
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Address Line | 619 W. 37TH STREET
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City | SAVANNAH
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State | GA
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Zip | 31415
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Country | US
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Telephone | 912-335-2508
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Fax | 912-335-2543
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Authorized Official
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Title or Position | CEO/PRIMARY OFFICER
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Name | DR. PATRICIA A. ENGLISH
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Credential | PHD, LPC
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Telephone | 912-604-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 002835
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License Number State | GA
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