Organization Name: | JAG'S DEVELOPMENTAL DISABILITY ADULT CARE |
NPI Number: | 1093850620 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GWENDOLYN JOHNS (EXECUTIVE DIRECTOR) |
Mailing Address: | 1006 Laurel Leaf Rd 1005 Laurel Leaf Road Zebulon |
State: | NC US |
Postal Code: | 275976715 |
Phone Number: | 9192696107 |
Fax Number: | 9194041515 |
NPI Enumeration Date: | 02/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | MHL-092-639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |