Healthcare Provider Details

I. General information

NPI: 1134478779
Provider Name (Legal Business Name): JNN HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LEGGETT ST
LUMBERTON NC
28358-7335
US

IV. Provider business mailing address

109 LEGGETT ST
LUMBERTON NC
28358-7335
US

V. Phone/Fax

Practice location:
  • Phone: 910-374-2234
  • Fax:
Mailing address:
  • Phone: 910-374-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC4567
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4567
License Number StateNC

VIII. Authorized Official

Name: SHEKILA OYANA DUPREE
Title or Position: OWNER/CEO/AGENCY DIRECTOR
Credential: LPN
Phone: 910-374-2234