Healthcare Provider Details

I. General information

NPI: 1194816165
Provider Name (Legal Business Name): D & J ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S MARSHALL ST BOX 81
WINSTON SALEM NC
27101-5852
US

IV. Provider business mailing address

1001 S MARSHALL ST BOX 81
WINSTON SALEM NC
27101-5852
US

V. Phone/Fax

Practice location:
  • Phone: 336-722-4777
  • Fax: 336-722-0097
Mailing address:
  • Phone: 336-722-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2988
License Number StateNC

VIII. Authorized Official

Name: MRS. JUDITH ANITA RUSSELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-722-4777