=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851415012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOFLO SPECIALTY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2303 NC HIGHWAY 55
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-768-8405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2303 NC HIGHWAY 55
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-768-8405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER ADMINISTRATOR
-----------------------------------------------------
Name | MR. JOSEPH BOTCHWAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-768-8405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------