Healthcare Provider Details

I. General information

NPI: 1588298863
Provider Name (Legal Business Name): JAYCEE'S HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 SIX FORKS RD STE 201
RALEIGH NC
27609-8617
US

IV. Provider business mailing address

5710 SIX FORKS RD STE 201
RALEIGH NC
27609-8617
US

V. Phone/Fax

Practice location:
  • Phone: 919-862-4626
  • Fax:
Mailing address:
  • Phone: 919-862-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JAYCEE JOHNSON
Title or Position: OWNER
Credential:
Phone: 919-862-4625