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
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
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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