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General NPI Number Information
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NPI Number | 1336372051
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Entity Type | Organization
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Legal Business Name | JMJ ENTERPRISES, LLC
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 2020 TEXTILE DR
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City | GREENSBORO
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State | NC
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Zip | 27405-5857
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Country | US
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Telephone | 336-271-6982
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Fax | 336-271-6982
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Provider Business Mailing Address
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Address Line | 2 LOXWOOD CT
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City | GREENSBORO
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State | NC
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Zip | 27405-9728
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Country | US
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Telephone | 336-271-6982
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Fax | 336-271-6982
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Authorized Official
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Title or Position | DIRECTOR/ OWNER
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Name | MS. TRACI JOHNSON MARTIN
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Credential |
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Telephone | 336-988-1552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL041857
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License Number State | NC
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