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General NPI Number Information
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NPI Number | 1508452491
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Entity Type | Individual
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Provider Name | DEBORAH JEAN JACOBY
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 115 W WILLOWAY DR
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City | BOISE
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State | ID
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Zip | 83705-5937
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Country | US
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Telephone | 208-345-6625
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 W PINE AVE
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City | BOISE
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State | ID
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Zip | 83703-4850
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Country | US
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Telephone | 208-608-6114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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