Provider Demographics
NPI:1255928388
Name:JESSIE'S WORLD INC
Entity type:Organization
Organization Name:JESSIE'S WORLD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DEVELOPMENT OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CBOS
Authorized Official - Phone:980-263-9670
Mailing Address - Street 1:PO BOX 480635
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5305
Mailing Address - Country:US
Mailing Address - Phone:980-263-9670
Mailing Address - Fax:
Practice Address - Street 1:1000 BAXTER ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2859
Practice Address - Country:US
Practice Address - Phone:980-263-9670
Practice Address - Fax:980-430-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health