Healthcare Provider Details

I. General information

NPI: 1952717787
Provider Name (Legal Business Name): JG CONSULTANT CORP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 JOHNNIE DODDS BLVD SUITE 125
MOUNT PLEASANT SC
29464-6100
US

IV. Provider business mailing address

997 JOHNNIE DODDS BLVD SUITE 125
MOUNT PLEASANT SC
29464-6100
US

V. Phone/Fax

Practice location:
  • Phone: 184-397-8036
  • Fax:
Mailing address:
  • Phone: 184-397-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number102153369
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number102153369
License Number StateSC

VIII. Authorized Official

Name: JOSHUA GLINCMAN
Title or Position: OWNER
Credential:
Phone: 843-972-8036