Provider Demographics
NPI:1154739472
Name:JACOB'S NURSING AGENCY
Entity type:Organization
Organization Name:JACOB'S NURSING AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMISTERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOPSIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINSTERATOR
Authorized Official - Phone:718-941-4295
Mailing Address - Street 1:543 OCEAN AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3836
Mailing Address - Country:US
Mailing Address - Phone:347-312-2925
Mailing Address - Fax:
Practice Address - Street 1:543 OCEAN AVE APT 6C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3836
Practice Address - Country:US
Practice Address - Phone:347-312-2925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317405-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health