Provider Demographics
NPI:1811204811
Name:JENNINGS PLACE INC.
Entity Type:Organization
Organization Name:JENNINGS PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:LOLITA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:936-572-8153
Mailing Address - Street 1:614 COUNTY ROAD 2230
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-6177
Mailing Address - Country:US
Mailing Address - Phone:936-572-8153
Mailing Address - Fax:936-275-9732
Practice Address - Street 1:614 COUNTY ROAD 2230
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-6177
Practice Address - Country:US
Practice Address - Phone:936-572-8153
Practice Address - Fax:936-275-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services