Organization
KINGS & QUEENS YOUTH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA J JACOBS MSCJ, QMHS, CDCA (FOUNDER)
(419) 206-9023
Entity
Organization
Contact information
Practice address
430 NEBRASKA AVE, TOLEDO, OH 43604-8540
(419) 671-5400
Mailing address
3550 EXECUTIVE PKWY STE 7-189, TOLEDO, OH 43606-1379
(419) 206-9023
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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