Jabez Residential Inc

Primary specialty

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

License

MHL051174 Issued in NC

Legal business name

JABEZ RESIDENTIAL INC

Practice address

212 Tilghman Street
Kenly, NC 27542-1214

Phone

(919) 284-3723

NPI assigned

Jul 23, 2009

Organization subpart

No

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

Authorized official

Name

Damien K Forsythe

Title

Owner

Phone

(919) 284-3723

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248307200000",
    "number": "1629208699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1214",
            "city": "KENLY",
            "state": "NC",
            "postal_code": "275421214",
            "telephone_number": "919-284-3723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 TILGHMAN STREET",
            "city": "KENLY",
            "state": "NC",
            "postal_code": "275421214",
            "telephone_number": "919-284-3723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JABEZ RESIDENTIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-23",
        "last_updated": "2009-07-23",
        "status": "A",
        "authorized_official_last_name": "FORSYTHE",
        "authorized_official_first_name": "DAMIEN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-284-3723"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL051174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kenly, NC
• Providers in Kenly, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; 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.