Provider Demographics
NPI:1154038032
Name:JIREH WAY FAMILY GROUP HOME LLC
Entity type:Organization
Organization Name:JIREH WAY FAMILY GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-366-9258
Mailing Address - Street 1:8431 N SERVITE DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6206
Mailing Address - Country:US
Mailing Address - Phone:414-366-9258
Mailing Address - Fax:414-368-0111
Practice Address - Street 1:8106 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4532
Practice Address - Country:US
Practice Address - Phone:414-366-9258
Practice Address - Fax:414-368-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care