Organization
JABEZ RESIDENTIAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMIEN K FORSYTHE (OWNER)
(919) 284-3723
Entity
Organization
Contact information
Practice address
212 TILGHMAN STREET, KENLY, NC 27542-1214
(919) 284-3723
Mailing address
PO BOX 1214, KENLY, NC 27542-1214
(919) 284-3723
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL051174
NC
Other
Enumeration date
07/23/2009
Last updated
07/23/2009
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