Provider Demographics
NPI:1962540989
Name:JEHOVAH JIREH ENTERPRISES, LLC
Entity type:Organization
Organization Name:JEHOVAH JIREH ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEEZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-993-1146
Mailing Address - Street 1:5534 OLD NATIONAL HIGHWAY
Mailing Address - Street 2:SUITE 150E
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349
Mailing Address - Country:US
Mailing Address - Phone:404-993-1146
Mailing Address - Fax:678-799-7651
Practice Address - Street 1:5534 OLD NATIONAL HIGHWAY
Practice Address - Street 2:SUITE 150E
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349
Practice Address - Country:US
Practice Address - Phone:404-993-1146
Practice Address - Fax:678-799-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900809AMedicaid
GA000900809BMedicaid
GA000900809BMedicaid