Provider Demographics
NPI:1164061313
Name:JADES-NISSI HOME CARE, LLC
Entity Type:Organization
Organization Name:JADES-NISSI HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AFOLASHADE
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:OLAOYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-520-3818
Mailing Address - Street 1:5710 SIX FORKS RD STE 15
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-0041
Mailing Address - Country:US
Mailing Address - Phone:919-520-3818
Mailing Address - Fax:
Practice Address - Street 1:5710 SIX FORKS RD STE 15
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-0041
Practice Address - Country:US
Practice Address - Phone:919-520-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care