Organization
JEREMY'S PLACE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATEISHA NICHOL JACKSON-BROWN (OWNER)
(770) 969-9334
Entity
Organization
Contact information
Practice address
4910 JONESBORO RD STE 201, UNION CITY, GA 30291-2087
(770) 969-9334
(770) 969-9337
Mailing address
4910 JONESBORO RD STE 201, UNION CITY, GA 30291-2087
(770) 969-9334
(770) 969-9337
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003203627A
—
GA
05
—
003203627B
—
GA
05
—
604196354A
—
GA
05
—
604196354B
—
GA
Enumeration date
07/04/2020
Last updated
07/04/2020
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