MEDICARE: JAYREESE CONTRACTING,INC.

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578634572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYREESE CONTRACTING,INC.

Provider Business Mailing Address
First Line	:	PO BOX 1583
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-1583
Country	:	US
Telephone Number	:	843-838-3295
Fax Number	:	843-838-4766

Provider Business Practice Location Address
First Line	:	22 OLD POLOWANA ROAD
Second Line	:
City	:	ST. HELENA ISLAND
State	:	SC
Zip	:	29920-1583
Country	:	US
Telephone Number	:	843-838-3295
Fax Number	:	843-838-4766

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DORA D. JAMES
Credential	:	MSW
Telephone Number	:	843-838-3295

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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