Provider Demographics
NPI:1942714522
Name:J.A.C. UNLIMITED, INC.
Entity Type:Organization
Organization Name:J.A.C. UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-273-0386
Mailing Address - Street 1:5328 ARTESA CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2391
Mailing Address - Country:US
Mailing Address - Phone:704-273-0386
Mailing Address - Fax:
Practice Address - Street 1:5328 ARTESA CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-2391
Practice Address - Country:US
Practice Address - Phone:704-273-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities