Organization
JOHN & JENNERINE ENTERPRISE, INC.
Active
Other names
Life Turn
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN ROBERT WALLACE (OWNER/EFT)
(336) 342-2609
Entity
Organization
Contact information
Practice address
3008 NC HIGHWAY 150, REIDSVILLE, NC 27320-8112
(336) 342-2609
(336) 342-6362
Mailing address
PO BOX 1583, REIDSVILLE, NC 27323-1583
(336) 342-2609
(336) 342-6362
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-079-058
NC
Other
Enumeration date
01/10/2007
Last updated
04/25/2011
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