Provider Demographics
NPI:1861008179
Name:MAGGIE JANES LLC
Entity Type:Organization
Organization Name:MAGGIE JANES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-415-1659
Mailing Address - Street 1:PO BOX 20053
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-0053
Mailing Address - Country:US
Mailing Address - Phone:919-415-1659
Mailing Address - Fax:
Practice Address - Street 1:3004 HILLMER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7810
Practice Address - Country:US
Practice Address - Phone:919-415-1659
Practice Address - Fax:919-415-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management