Provider Demographics
NPI:1356123772
Name:JRG SPECIAL HOLDINGS, LLC
Entity type:Organization
Organization Name:JRG SPECIAL HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-304-4910
Mailing Address - Street 1:2 BUCKTHORN CT
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2917
Mailing Address - Country:US
Mailing Address - Phone:856-304-4910
Mailing Address - Fax:
Practice Address - Street 1:2 BUCKTHORN CT
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2917
Practice Address - Country:US
Practice Address - Phone:856-304-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage