Healthcare Provider Details

I. General information

NPI: 1851415012
Provider Name (Legal Business Name): JOFLO SPECIALTY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 NC HIGHWAY 55
DURHAM NC
27707-4901
US

IV. Provider business mailing address

2303 NC HIGHWAY 55
DURHAM NC
27707-4901
US

V. Phone/Fax

Practice location:
  • Phone: 919-768-8405
  • Fax:
Mailing address:
  • Phone: 919-768-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH BOTCHWAY
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 919-768-8405