Provider Demographics
NPI:1710170683
Name:JACKSON COUNTY DSS
Entity Type:Organization
Organization Name:JACKSON COUNTY DSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JUNALUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-587-2042
Mailing Address - Street 1:15 GRIFFIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8630
Mailing Address - Country:US
Mailing Address - Phone:828-587-2042
Mailing Address - Fax:828-587-2099
Practice Address - Street 1:15 GRIFFIN ST
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8630
Practice Address - Country:US
Practice Address - Phone:828-587-2042
Practice Address - Fax:828-587-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700075Medicaid