MEDICARE: J.A.C. UNLIMITED, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1942714522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.A.C. UNLIMITED, INC.

Provider Business Mailing Address
First Line	:	5328 ARTESA CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2391
Country	:	US
Telephone Number	:	704-273-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	5328 ARTESA CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2391
Country	:	US
Telephone Number	:	704-273-0386
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LATASHA EARL
Credential	:
Telephone Number	:	704-273-0386

Provider Enumeration Date	:	11/19/2017
Last Update Date	:	11/19/2017

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