MEDICARE: HUNTER J GROUP LLC

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	251S00000X	Community/Behavioral Health Agency
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1386264315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTER J GROUP LLC

Provider Business Mailing Address
First Line	:	600 OLEANDER RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-2714
Country	:	US
Telephone Number	:	919-827-7812
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 US HIGHWAY 1 N
Second Line	:
City	:	NORLINA
State	:	NC
Zip	:	27563-9598
Country	:	US
Telephone Number	:	919-827-7812
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	VALERIE D JORDAN
Credential	:
Telephone Number	:	919-827-7812

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	04/20/2020

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