Provider Demographics
NPI:1629960711
Name:JACOB'S REHAB SERVICES LLC
Entity type:Organization
Organization Name:JACOB'S REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AZARAYAH
Authorized Official - Middle Name:JAEL-DOVE
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-414-3007
Mailing Address - Street 1:7104 MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6033
Mailing Address - Country:US
Mailing Address - Phone:405-414-3007
Mailing Address - Fax:
Practice Address - Street 1:7104 MEADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6033
Practice Address - Country:US
Practice Address - Phone:405-414-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty