JABEZ CUSTOMIZED LIVING SERVICES
NPI 1487136206
Home Health in Brooklyn Park, MN
NPI Status: Active since August 29, 2018
Contact Information
1417 BROOKDALE DR
BROOKLYN PARK, MN
ZIP 55444
Phone: (612) 272-8009
Fax: (612) 601-8962
- Organization
- Home Health
- CLIA Number: 24D2305002
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 05-21-2028
About JABEZ CUSTOMIZED LIVING SERVICES
This page provides the complete NPI Profile along with additional information for Jabez Customized Living Services, a provider established in Brooklyn Park, Minnesota operating as a Home Health. The healthcare provider is registered in the NPI registry with number 1487136206 assigned on August 2018. The practitioner's primary taxonomy code is 251E00000X. The provider is registered as an organization and their NPI record was last updated 7 years ago. The provider's is doing business as Jabez Customized Living Services. The authorized official of this NPI record is Pandora Lee White Cnp (Director Of Operations/owner)
- NPI
- 1487136206
- Provider Legal Name
- JABEZ CUSTOMIZED LIVING SERVICES
- Other Organization Name
- JABEZ CUSTOMIZED LIVING SERVICES
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1417 BROOKDALE DR BROOKLYN PARK, MN 55444
- Location Phone
- (612) 272-8009
- Location Fax
- (612) 601-8962
- Mailing Address
- 1417 BROOKDALE DR MINNEAPOLIS, MN 55444
- Mailing Phone
- (612) 272-8009
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 08-29-2018
- Last Update Date
- 01-11-2019
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Home Health
- Taxonomy Code
- 251E00000X
- Type
- Agencies
- Taxonomy Description
- A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2305002
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- May 22, 2026
- Certificate Expiration Date
- May 21, 2028
- Laboratory Director
- PANDORA L. WHITE
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Jabez Customized Living Services to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1487136206, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 54. The final step is to find the difference between that total and the next multiple of ten (60 - 54 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 54 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1487136206, enumerated as an "organization" on August 29, 2018.
The provider is located at 1417 BROOKDALE DR BROOKLYN PARK, MN 55444 and the phone number is (612) 272-8009.
Home Health with taxonomy code 251E00000X.
