Supreme Council of the House of Jacob of the USA Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2436 Issued in OH

Legal business name

SUPREME COUNCIL OF THE HOUSE OF JACOB OF THE USA INC

Doing business as

Jacob's Dwelling Nursing Home

Practice address

25680 Township Rd. 39
Coshocton, OH 43812-9195

Phone

(740) 824-3635

Fax

(740) 824-5205

NPI assigned

Nov 6, 2006

Organization subpart

No

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

Authorized official

Name

Huldah M. Chesnut, NHA

Title

Administrator

Phone

(740) 824-3635

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jacob's Dwelling Nursing Home Doing business as

Locations

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248307200000",
    "number": "1891864823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25680 TOWNSHIP RD. 39",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438129195",
            "telephone_number": "740-824-3635",
            "fax_number": "740-824-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25680 TOWNSHIP RD. 39",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438129195",
            "telephone_number": "740-824-3635",
            "fax_number": "740-824-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME COUNCIL OF THE HOUSE OF JACOB OF THE USA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2009-07-23",
        "status": "A",
        "authorized_official_last_name": "CHESNUT",
        "authorized_official_first_name": "HULDAH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "740-824-3635",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0280619",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacob's Dwelling Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Megan Stubbs
• Jennifer L Swartz, PT
• Jodi Taylor
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• Melissa D Thomas
• Shannon E Thomas, CDCA

• Skilled Nursing Facility in Coshocton, OH
• Providers in Coshocton, OH by specialty
• Skilled Nursing Facility in Ohio

• 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.