Provider Demographics
NPI:1053602367
Name:JABEZ EMPOWERMENT, LLC
Entity type:Organization
Organization Name:JABEZ EMPOWERMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CLARDY
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-906-3993
Mailing Address - Street 1:375 DOVER RD STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4144
Mailing Address - Country:US
Mailing Address - Phone:931-906-3993
Mailing Address - Fax:931-503-0472
Practice Address - Street 1:175 STATELINE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:OAK GROVE
Practice Address - State:KY
Practice Address - Zip Code:42262
Practice Address - Country:US
Practice Address - Phone:931-906-3993
Practice Address - Fax:931-503-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251E00000X, 251S00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1053602367Medicaid
TN65Medicaid