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JABEZ CUSTOMIZED LIVING SERVICES
NPI 1487136206
Home Health in Brooklyn Park, MN

Active since August 29, 2018CLIA 24D2305002 · Waiver
1417 BROOKDALE DR, BROOKLYN PARK, MN 55444(612) 272-8009(612) 601-8962 Get Directions Write a Review

NPPES record last updated: January 11, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 11, 2019, Aug 29, 2018 (2 updates tracked since 2018).

About Jabez Customized Living Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JABEZ CUSTOMIZED LIVING SERVICES (NPI 1487136206) is a healthcare organization registered as a home health in Brooklyn Park, Minnesota and active in the NPI registry since August 2018. The organization holds a CLIA Waiver certificate valid through May 21, 2028 and lists Pandora Lee White, Director Of Operations/owner, as its authorized official.

NPPES Registry Identity

NPI1487136206
Entity TypeOrganization
Primary Taxonomy251E00000X
Legal Business NameJABEZ CUSTOMIZED LIVING SERVICES
Location Address1417 BROOKDALE DRBrooklyn Park, MN 55444-2129
Mailing Address1417 Brookdale DrMinneapolis, MN 55444-2129 · (612) 272-8009
Phone(612) 272-8009
Fax(612) 601-8962
Organization SubpartYesParent: Urban Hope Ministries Inc
Authorized OfficialPandora Lee WhiteDirector Of Operations/owner · (612) 272-8009
Enumeration DateAugust 29, 2018
Last NPPES UpdateJanuary 11, 20192 updates tracked since enumeration
✔ NPI 1487136206 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyHome HealthAgencies
Taxonomy Code251E00000X
Definition
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.
1417 BROOKDALE DR, Brooklyn Park, MN 55444
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Other Names 1

Doing Business AsJabez Customized Living Services

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2305002

Jabez Customized Living Services · Brooklyn Park, MN
Active · expires May 21, 2028
CLIA Number24D2305002
Laboratory TypeAssisted Living Facility
Certificate Effective DateMay 22, 2026
Certificate Expiration DateMay 21, 2028
Laboratory DirectorPandora L. White
Laboratory Phone(612) 272-8009
Laboratory LocationJabez Customized Living Services1417 Brookdale Dr, Brooklyn Park, MN 55444
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jabez Customized Living Services's NPI number?

The NPI number for Jabez Customized Living Services is 1487136206. It was assigned to this organization in the NPPES registry on August 29, 2018.

Where is Jabez Customized Living Services located?

Jabez Customized Living Services is located at 1417 Brookdale Dr, Brooklyn Park, MN 55444. The listed phone number is (612) 272-8009.

What is Jabez Customized Living Services's specialty?

The primary specialty registered for this NPI is Home Health with taxonomy code 251E00000X.

Does Jabez Customized Living Services hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2305002) is associated with this NPI, valid through May 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jabez Customized Living Services was last updated on January 11, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.