Provider Demographics
NPI:1811440209
Name:HOUSE OF JACOB HEALTH SERVICES
Entity type:Organization
Organization Name:HOUSE OF JACOB HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:CLARISSE
Authorized Official - Last Name:WANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-251-8477
Mailing Address - Street 1:316 FILMORE ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7810
Mailing Address - Country:US
Mailing Address - Phone:504-305-0035
Mailing Address - Fax:504-305-0004
Practice Address - Street 1:316 FILMORE ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7810
Practice Address - Country:US
Practice Address - Phone:504-305-0035
Practice Address - Fax:504-305-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder