Individual ProviderJacob ChamberlainStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address20000 N 57th Ave Rm K102, Glendale, AZ 85308-6987(801) 367-5076PECOS EnrollmentBased on the most recent information from CMS, provider Jacob Chamberlain does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 1:10 PM.Profile DetailsProvider ID1225614019Provider TypeIndividualFull NameChamberlain, JacobGenderMaleSole ProprietorNoEnumeration Date3/22/2021Last Updated3/22/2021Contact InformationPractice LocationPractice Address20000 N 57th Ave Rm K102, Glendale, AZ 85308-6987Phone(801) 367-5076FaxUnlisted FaxMailing LocationMailing Address20000 N 57th Ave Rm K102, Glendale, AZ 85308-6987PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer