MEDICARE: HOUSE OF JOBA

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	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1396021465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF JOBA

Provider Business Mailing Address
First Line	:	3319 KRISTIN COURT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-3106
Country	:	US
Telephone Number	:	614-558-5171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3319 KRISTIN COURT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-3106
Country	:	US
Telephone Number	:	614-558-5171
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	SHARON M LEE
Credential	:
Telephone Number	:	614-558-5171

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	02/25/2017

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Directions to “HOUSE OF JOBA ” Practice Location

Language	Start Address	Practice Location

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