Provider Demographics
NPI:1295864908
Name:JEG'S OUTREACH, INC.
Entity Type:Organization
Organization Name:JEG'S OUTREACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-864-9909
Mailing Address - Street 1:2324 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4230
Mailing Address - Country:US
Mailing Address - Phone:910-864-9909
Mailing Address - Fax:910-488-3401
Practice Address - Street 1:2324 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4230
Practice Address - Country:US
Practice Address - Phone:910-864-9909
Practice Address - Fax:910-488-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3434251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601541Medicaid