Jabez Customized Living Services

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

JABEZ CUSTOMIZED LIVING SERVICES

Practice address

1417 Brookdale Dr
Brooklyn Park, MN 55444-2129

Phone

(612) 272-8009

Fax

(612) 601-8962

NPI assigned

Aug 29, 2018

Organization subpart

Yes

Parent organization

URBAN HOPE MINISTRIES INCAs reported in NPPES

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

Authorized official

Name

Pandora Lee White, CNP

Title

Director of Operations/Owner

Phone

(612) 272-8009

Specialties & licenses 1

Addresses

Other names 1

• Jabez Customized Living Services Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Jabez Customized Living Services

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547164800000",
    "number": "1487136206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 BROOKDALE DR",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554442129",
            "telephone_number": "612-272-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 BROOKDALE DR",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554442129",
            "telephone_number": "612-272-8009",
            "fax_number": "612-601-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JABEZ CUSTOMIZED LIVING SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "URBAN HOPE MINISTRIES INC",
        "enumeration_date": "2018-08-29",
        "last_updated": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "PANDORA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS/OWNER",
        "authorized_official_telephone_number": "612-272-8009",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jabez Customized Living Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jabez Customized Living Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.