Provider Demographics
NPI:1144675430
Name:JACOB'S LADDER YOUTH FOUNDATION
Entity type:Organization
Organization Name:JACOB'S LADDER YOUTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRIEL
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:240-691-3619
Mailing Address - Street 1:1616 SARATOGA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4186
Mailing Address - Country:US
Mailing Address - Phone:240-691-3619
Mailing Address - Fax:
Practice Address - Street 1:1616 SARATOGA CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4186
Practice Address - Country:US
Practice Address - Phone:240-691-3619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty