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Organization
JESSIE'S PLACE
Active
Organization
JESSIE'S PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS WILLIAMS (ADMINISTRATOR)
(252) 257-1814
Entity
Organization
Contact information
Practice address
516 MACON EMBRO RD, MACON, NC 27551-9287
(252) 257-1814
Mailing address
516 MACON EMBRO RD, MACON, NC 27551-9287
(252) 257-1814
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-093-043
NC
Other
Enumeration date
02/04/2008
Last updated
02/04/2008
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