Provider Demographics
NPI:1033318969
Name:J-LO HOMES, LLC
Entity Type:Organization
Organization Name:J-LO HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:919-222-2407
Mailing Address - Street 1:400 S PINEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6039
Mailing Address - Country:US
Mailing Address - Phone:919-734-3924
Mailing Address - Fax:919-734-4950
Practice Address - Street 1:208 RANDALL LN
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8837
Practice Address - Country:US
Practice Address - Phone:919-221-6719
Practice Address - Fax:919-734-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-096-200320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness