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General NPI Number Information
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NPI Number | 1255512877
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Entity Type | Organization
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Legal Business Name | JADA'S HOUSE,LLC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 3987 STERLING POINTE DR LLL-1
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City | WINTERVILLE
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State | NC
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Zip | 28590-9243
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Country | US
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Telephone | 252-830-3934
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2193
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City | GREENVILLE
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State | NC
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Zip | 27836-0193
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Country | US
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Telephone | 252-412-0797
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. NICOLE TAFT
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Credential |
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Telephone | 252-412-0797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-074-187
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License Number State | NC
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