Provider Demographics
NPI:1497085252
Name:JCS REHABILITATION & WELLNESS CENTER,PLLC
Entity Type:Organization
Organization Name:JCS REHABILITATION & WELLNESS CENTER,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:910-215-7155
Mailing Address - Street 1:1902 N SANDHILLS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2382
Mailing Address - Country:US
Mailing Address - Phone:910-215-7155
Mailing Address - Fax:910-944-5901
Practice Address - Street 1:1902 N SANDHILLS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2382
Practice Address - Country:US
Practice Address - Phone:910-215-7155
Practice Address - Fax:910-944-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7235225100000X
NC2301225200000X
NC8637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413676Medicaid
NC7413676Medicaid