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Organization
JAG'S RESIDENTIAL SERVICES, LLC
Active
Organization
JAG'S RESIDENTIAL SERVICES, LLC
Active
Other names
JAG'S Developmental Disability Adult Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GWENDOLYN GOOLSBY JOHNS (OWNER / DIRECTOR)
(919) 426-3752
Entity
Organization
Contact information
Practice address
1005 LAUREL LEAF RD, ZEBULON, NC 27597
(919) 426-3752
(919) 404-1515
Mailing address
1006 LAUREL LEAF RD, ZEBULON, NC 27597
(919) 426-3752
(919) 404-1515
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
—
NULL
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-092-639
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805466
—
NC
Enumeration date
02/21/2007
Last updated
09/08/2021
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