MEDICARE: JNJ HOMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1568249852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JNJ HOMES

Provider Business Mailing Address
First Line	:	11431 NORTHWOODS FOREST DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-8814
Country	:	US
Telephone Number	:	631-994-4253
Fax Number	:

Provider Business Practice Location Address
First Line	:	11431 NORTHWOODS FOREST DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-8814
Country	:	US
Telephone Number	:	631-994-4253
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JAYEE KABBA
Credential	:
Telephone Number	:	631-994-4253

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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