Healthcare Provider Details

I. General information

NPI: 1295864908
Provider Name (Legal Business Name): JEG'S OUTREACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 HOPE MILLS RD
FAYETTEVILLE NC
28304-4230
US

IV. Provider business mailing address

2324 HOPE MILLS RD
FAYETTEVILLE NC
28304-4230
US

V. Phone/Fax

Practice location:
  • Phone: 910-864-9909
  • Fax: 910-488-3401
Mailing address:
  • Phone: 910-864-9909
  • Fax: 910-488-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3434
License Number StateNC

VIII. Authorized Official

Name: MR. JIMMIE L COX JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-864-9909