Healthcare Provider Details

I. General information

NPI: 1285943753
Provider Name (Legal Business Name): JMJ ENTERPRISES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 W MEADOWVIEW RD SUITE 109
GREENSBORO NC
27407-3406
US

IV. Provider business mailing address

2020 TEXTILE DR
GREENSBORO NC
27405-5857
US

V. Phone/Fax

Practice location:
  • Phone: 336-617-0469
  • Fax: 888-502-5943
Mailing address:
  • Phone: 336-271-6982
  • Fax: 336-271-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACI MARTIN
Title or Position: OWNER/CEO
Credential:
Phone: 336-271-6982