=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548595150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEBCO PRIVATE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2009
-----------------------------------------------------
Last Update Date | 10/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1233 S HWY 160
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-209-4961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 491
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89041-0491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-209-4961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER / CEO
-----------------------------------------------------
Name | MR. ROBERT JOHN BOWNE
-----------------------------------------------------
Credential | MA PCA
-----------------------------------------------------
Telephone | 775-209-4961
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------