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General NPI Number Information
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NPI Number | 1619479441
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Entity Type | Organization
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Legal Business Name | JACOB HOUSE
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 13420 W WARREN AVE
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City | LAKEWOOD
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State | CO
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Zip | 80228-4616
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Country | US
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Telephone | 303-525-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 13420 W WARREN AVE
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City | LAKEWOOD
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State | CO
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Zip | 80228-4616
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Country | US
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Telephone | 303-525-6141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DAVID HOPE MITCHELL
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Credential |
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Telephone | 303-525-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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