Healthcare Provider Details

I. General information

NPI: 1710203484
Provider Name (Legal Business Name): JMJ ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
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

3911 SE JACK PINE CT
GREENSBORO NC
27406-8765
US

V. Phone/Fax

Practice location:
  • Phone: 336-617-0469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GARVEY PRESLEY III
Title or Position: MANAGER
Credential:
Phone: 336-456-5263