| NPI | 1093850620 |
|---|---|
| Former Legal Business Name | JAG'S DEVELOPMENTAL DISABILITY ADULT CARE, LLC |
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN GOOLSBY JOHNS Owner / Director 919-426-3752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-092-639) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2021-09-08 |