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General NPI Number Information
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NPI Number | 1811329337
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Entity Type | Organization
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Legal Business Name | JUST LIKE HOME FC LLC
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 617 DURHAM ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2305
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Country | US
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Telephone | 336-693-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 617 DURHAM ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2305
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Country | US
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Telephone | 336-693-1581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMEKA MICHELL JACKSON
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Credential |
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Telephone | 336-693-1581
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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 | FCL-001-150
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License Number State | NC
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