Provider Demographics
NPI:1245414556
Name:JAYREESE CONTRACTING INC
Entity Type:Organization
Organization Name:JAYREESE CONTRACTING INC
Other - Org Name:JAYREESE HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:843-838-3295
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-1583
Mailing Address - Country:US
Mailing Address - Phone:843-838-3295
Mailing Address - Fax:843-838-4766
Practice Address - Street 1:22 POLWANNA RD EXTENSION
Practice Address - Street 2:
Practice Address - City:STAINT HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920-1853
Practice Address - Country:US
Practice Address - Phone:843-838-3295
Practice Address - Fax:843-838-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0836Medicaid