Provider Demographics
NPI:1396171096
Name:JABEZ OUTREACH CENTER INC,
Entity type:Organization
Organization Name:JABEZ OUTREACH CENTER INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:CARE PROVIDER
Authorized Official - Phone:281-689-7839
Mailing Address - Street 1:2307 HUMMINGBIRD ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-3442
Mailing Address - Country:US
Mailing Address - Phone:281-689-7839
Mailing Address - Fax:281-689-7839
Practice Address - Street 1:2307 HUMMINGBIRD ST
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-3442
Practice Address - Country:US
Practice Address - Phone:281-689-7839
Practice Address - Fax:281-689-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135784310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility