Provider Demographics
NPI:1942862487
Name:JK2C, LLC
Entity Type:Organization
Organization Name:JK2C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:757-848-3478
Mailing Address - Street 1:105 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3361
Mailing Address - Country:US
Mailing Address - Phone:252-333-1540
Mailing Address - Fax:252-333-1548
Practice Address - Street 1:800 PARK ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2769
Practice Address - Country:US
Practice Address - Phone:757-848-3478
Practice Address - Fax:252-333-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health