Provider Demographics
NPI:1558034181
Name:JEWEL COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:JEWEL COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LCAS LISW-CP
Authorized Official - Phone:984-292-4235
Mailing Address - Street 1:1712 SUN STAR DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-7281
Mailing Address - Country:US
Mailing Address - Phone:919-649-0903
Mailing Address - Fax:
Practice Address - Street 1:1003 W MAIN ST STE B2
Practice Address - Street 2:
Practice Address - City:HAW RIVER
Practice Address - State:NC
Practice Address - Zip Code:27258-8931
Practice Address - Country:US
Practice Address - Phone:877-775-3935
Practice Address - Fax:866-545-3560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWEL COMMUNITY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health