Provider Demographics
NPI:1699924928
Name:ST. JAMES STREET, PLLC
Entity type:Organization
Organization Name:ST. JAMES STREET, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOBOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:480-577-4546
Mailing Address - Street 1:1049 E SOUTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6058
Mailing Address - Country:US
Mailing Address - Phone:480-577-4546
Mailing Address - Fax:
Practice Address - Street 1:1049 E SOUTHSHORE DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-6058
Practice Address - Country:US
Practice Address - Phone:480-577-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services