Provider Demographics
NPI:1558609305
Name:JCM ADVOCATE DEVELOPMENT AND HUMAN SERVICES
Entity Type:Organization
Organization Name:JCM ADVOCATE DEVELOPMENT AND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERDONNIS
Authorized Official - Middle Name:CHONDRAY
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-794-6706
Mailing Address - Street 1:180 VISTA CIR
Mailing Address - Street 2:C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-1967
Mailing Address - Country:US
Mailing Address - Phone:336-794-6706
Mailing Address - Fax:336-723-9110
Practice Address - Street 1:180 VISTA CIR
Practice Address - Street 2:C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-1967
Practice Address - Country:US
Practice Address - Phone:336-794-6706
Practice Address - Fax:336-723-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care