# JAG'S RESIDENTIAL SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JAG'S Developmental Disability Adult Care, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093850620
- **Authorized official:** MRS. GWENDOLYN GOOLSBY JOHNS (OWNER / DIRECTOR)
- **Authorized official phone:** (919) 426-3752

## Contact information

- **Practice address:** 1005 LAUREL LEAF RD, ZEBULON, NC 27597
- **Practice address phone:** (919) 426-3752
- **Practice address fax:** (919) 404-1515
- **Mailing address:** 1006 LAUREL LEAF RD, ZEBULON, NC 27597
- **Mailing address phone:** (919) 426-3752
- **Mailing address fax:** (919) 404-1515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311Z00000X | Custodial Care Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | MHL-092-639 | NC | — |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 09/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805466 | — | NC |