Healthcare Provider Details

I. General information

NPI: 1376799585
Provider Name (Legal Business Name): JMJ ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 TEXTILE DR
GREENSBORO NC
27405-5857
US

IV. Provider business mailing address

2020 TEXTILE DR
GREENSBORO NC
27405-5857
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-6982
  • Fax: 336-419-0456
Mailing address:
  • Phone: 336-988-1552
  • Fax: 336-272-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-041-1095
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-041-1115
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL041857
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberMHL-041-1115
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-1115
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-1095
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberMHL0411095
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberMHL-041-1115
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberMHL-041-1095
License Number StateNC
# 12
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACI JOHNSON MARTIN
Title or Position: OWNER
Credential:
Phone: 336-375-3901