Provider Demographics
NPI:1134253875
Name:A PLACE FOR T.J. HEALTH CARE INC.
Entity type:Organization
Organization Name:A PLACE FOR T.J. HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LETITHIA
Authorized Official - Middle Name:PELHAM
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-505-0384
Mailing Address - Street 1:PO BOX 39732
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-9732
Mailing Address - Country:US
Mailing Address - Phone:336-505-0384
Mailing Address - Fax:336-505-0384
Practice Address - Street 1:5001 HEATHRIDGE TER
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8419
Practice Address - Country:US
Practice Address - Phone:336-505-0384
Practice Address - Fax:336-505-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL04177261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805511Medicaid