Healthcare Provider Details

I. General information

NPI: 1578682910
Provider Name (Legal Business Name): JENNYCCARRINGTON,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W GARRISON BLVD
GASTONIA NC
28052-4099
US

IV. Provider business mailing address

245 W GARRISON BLVD STE A
GASTONIA NC
28052-4090
US

V. Phone/Fax

Practice location:
  • Phone: 704-869-6480
  • Fax:
Mailing address:
  • Phone: 704-869-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNY C CARRINGTON
Title or Position: PRESIDENT
Credential:
Phone: 704-869-6480