Provider Demographics
NPI:1396021465
Name:HOUSE OF JOBA
Entity type:Organization
Organization Name:HOUSE OF JOBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-558-5171
Mailing Address - Street 1:3319 KRISTIN COURT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-3106
Mailing Address - Country:US
Mailing Address - Phone:614-558-5171
Mailing Address - Fax:
Practice Address - Street 1:3319 KRISTIN COURT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-3106
Practice Address - Country:US
Practice Address - Phone:614-558-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 251B00000X
OHRS762663347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251S00000XAgenciesCommunity/Behavioral Health
Yes251B00000XAgenciesCase Management