=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992274633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JMMJ, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2018
-----------------------------------------------------
Last Update Date | 11/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 CHAPEL HILL RD STE A
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-6576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-706-5543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 253
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-0253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-706-5543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY DIRECTOR/ OWNER
-----------------------------------------------------
Name | MRS. PATRICIA MCDANIEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-706-5543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------