Provider Demographics
NPI:1376799585
Name:JMJ ENTERPRISES
Entity Type:Organization
Organization Name:JMJ ENTERPRISES
Other - Org Name:FRESH START HOME FOR CHILDREN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-375-3901
Mailing Address - Street 1:2020 TEXTILE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5857
Mailing Address - Country:US
Mailing Address - Phone:336-988-1552
Mailing Address - Fax:336-272-6604
Practice Address - Street 1:2020 TEXTILE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5857
Practice Address - Country:US
Practice Address - Phone:336-271-6982
Practice Address - Fax:336-419-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1115251S00000X, 253Z00000X, 311ZA0620X, 385H00000X
NCMHL-041-1095251S00000X, 311ZA0620X, 385H00000X
NCMHL0411095253Z00000X
253Z00000X, 311Z00000X, 320800000X
NCMHL041857322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385H00000XRespite Care FacilityRespite Care