Provider Demographics
NPI:1114692514
Name:JDE ENTERPRISES LLC
Entity Type:Organization
Organization Name:JDE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-344-8704
Mailing Address - Street 1:1257 COMMERCIAL DR SW STE C
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5991
Mailing Address - Country:US
Mailing Address - Phone:770-906-3600
Mailing Address - Fax:678-609-5407
Practice Address - Street 1:1257 COMMERCIAL DR SW STE C
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5991
Practice Address - Country:US
Practice Address - Phone:770-344-8704
Practice Address - Fax:678-609-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care