Healthcare Provider Details

I. General information

NPI: 1336372051
Provider Name (Legal Business Name): JMJ ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 TEXTILE DR
GREENSBORO NC
27405-5857
US

IV. Provider business mailing address

2 LOXWOOD CT
GREENSBORO NC
27405-9728
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-6982
  • Fax: 336-271-6982
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 NumberMHL041857
License Number StateNC

VIII. Authorized Official

Name: MS. TRACI JOHNSON MARTIN
Title or Position: DIRECTOR/ OWNER
Credential:
Phone: 336-988-1552