Jakobs Home, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

JAKOBS HOME, LLC

Practice address

10074 Cody Driskell Rd Lot 2
Grand Bay, AL 36541-6134

Phone

(251) 366-1017

NPI assigned

Sep 17, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Dominique Z Nelson

Title

Executive Director

Phone

(251) 366-1017

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1083441752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10074 CODY DRISKELL RD LOT 2",
            "city": "GRAND BAY",
            "state": "AL",
            "postal_code": "365416134",
            "telephone_number": "251-366-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10074 CODY DRISKELL RD LOT 2",
            "city": "GRAND BAY",
            "state": "AL",
            "postal_code": "365416134",
            "telephone_number": "251-366-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAKOBS HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "251-366-1017",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Grand Bay, AL
• Providers in Grand Bay, AL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.