MEDICARE: JOELS PLACE ADULT HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-026-818	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295882751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOELS PLACE ADULT HOME

Provider Business Mailing Address
First Line	:	6739 SHAD CT
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391-9448
Country	:	US
Telephone Number	:	910-484-6005
Fax Number	:	910-401-1010

Provider Business Practice Location Address
First Line	:	6739 SHAD CT
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391-9448
Country	:	US
Telephone Number	:	910-484-6005
Fax Number	:	910-401-1010

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. ALEAN MCQUEEN LOVE
Credential	:	R.N.
Telephone Number	:	910-978-6083

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	12/31/2007

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Directions to “JOELS PLACE ADULT HOME ” Practice Location

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