Healthcare Provider Details

I. General information

NPI: 1770864290
Provider Name (Legal Business Name): JEMASSIE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 PHEASANT GLEN RD
CHARLOTTE NC
28214-8209
US

IV. Provider business mailing address

PO BOX 681421
CHARLOTTE NC
28216-0025
US

V. Phone/Fax

Practice location:
  • Phone: 704-399-3555
  • Fax:
Mailing address:
  • Phone: 704-399-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number194810
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number194810
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number194810
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number194810
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number194810
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number194810
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number194810
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number194810
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number194810
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number194810
License Number StateNC

VIII. Authorized Official

Name: MS. SHENITA RENEA COLSON
Title or Position: FOUNDER/PRESIDENT
Credential: BSN, MBA/MHA, CCM,
Phone: 704-399-3555