MEDICARE: JACOB'S HOPE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1215775846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB'S HOPE, INC.

Provider Business Mailing Address
First Line	:	1150 N COUNTRY CLUB DR STE 8
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-2537
Country	:	US
Telephone Number	:	602-618-6620
Fax Number	:	420-912-1677

Provider Business Practice Location Address
First Line	:	1150 N COUNTRY CLUB DR STE 8
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-2537
Country	:	US
Telephone Number	:	602-618-6620
Fax Number	:	480-912-1677

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JO JONES
Credential	:
Telephone Number	:	602-618-6620

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	04/15/2026

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Directions to “JACOB'S HOPE, INC. ” Practice Location

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