Healthcare Provider Details

I. General information

NPI: 1902280035
Provider Name (Legal Business Name): JFC MERIDIAN OPCO WINSTON SALEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 E 5TH ST
WINSTON SALEM NC
27101-3312
US

IV. Provider business mailing address

PO BOX 2568
HICKORY NC
28603-2568
US

V. Phone/Fax

Practice location:
  • Phone: 336-722-7119
  • Fax: 336-837-0212
Mailing address:
  • Phone: 828-322-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-034-100
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHARLES E TREFZGER
Title or Position: MANAGER
Credential:
Phone: 828-322-5535