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General NPI Number Information
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NPI Number | 1659739316
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Entity Type | Organization
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Legal Business Name | JONOGA, LLC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 6700 BARCLIFF DR
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City | CHARLOTTE
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State | NC
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Zip | 28212-8554
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Country | US
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Telephone | 980-319-2408
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Fax | 707-369-0084
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Provider Business Mailing Address
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Address Line | 6700 BARCLIFF DR
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City | CHARLOTTE
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State | NC
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Zip | 28212-8554
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Country | US
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Telephone | 980-319-2408
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Fax | 707-369-0084
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Authorized Official
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Title or Position | DIRECTOR
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Name | OGADINMA AKAGHA
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Credential |
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Telephone | 980-319-2408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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