Healthcare Provider Details

I. General information

NPI: 1528584398
Provider Name (Legal Business Name): JRTRANSI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 EMERALD WOOD DR
HUNTERSVILLE NC
28078-2419
US

IV. Provider business mailing address

10935 EMERALD WOOD DR
HUNTERSVILLE NC
28078-2419
US

V. Phone/Fax

Practice location:
  • Phone: 304-960-9348
  • Fax:
Mailing address:
  • Phone: 304-960-9348
  • Fax: 304-960-9348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberCCSI20285
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WANDA JEAN FRASER
Title or Position: OWNER
Credential: BA,ED
Phone: 304-960-9348