Organization
HOUSE OF JABEZ LLC
Active
Organization
HOUSE OF JABEZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLYDE RANDOLPH WILKINS (EXECUTIVE DIRECTOR)
19192426115
Entity
Organization
Contact information
Practice address
203 DOCK STREET, FREMONT, NC 27830-0662
(919) 242-1296
Mailing address
1516 A N. WILLIAM STREET, GOLDSBORO, NC 27530-1616
(919) 648-1190
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL 096-195
NC
Other
Enumeration date
05/09/2007
Last updated
08/22/2020
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