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General NPI Number Information
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NPI Number | 1558408898
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Entity Type | Organization
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Legal Business Name | JEFF'S PLACE
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1109 GRIFFITH RD
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City | MONROE
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State | NC
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Zip | 28112-6244
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Country | US
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Telephone | 704-226-8503
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Fax | 704-292-1915
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Provider Business Mailing Address
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Address Line | 410 ROBIN DR
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City | MONROE
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State | NC
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Zip | 28112-6478
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Country | US
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Telephone | 704-283-4295
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Fax | 704-292-1915
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFF MASSEY
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Credential |
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Telephone | 704-225-0584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | MHL090106
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License Number State | NC
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