Healthcare Provider Details

I. General information

NPI: 1871806869
Provider Name (Legal Business Name): J-JIREH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 SHOCCO SPRINGS RD
WARRENTON NC
27589-8715
US

IV. Provider business mailing address

188 SHOCCO SPRINGS RD
WARRENTON NC
27589-8715
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-9909
  • Fax:
Mailing address:
  • Phone: 252-257-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1097604
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1097604
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1097604
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number1097604
License Number StateNC

VIII. Authorized Official

Name: GERTIE WILLIAMS CRUTE
Title or Position: DIRECTOR
Credential: QP, LPN
Phone: 252-433-5103