Organization
JOHN & JENNERINE ENTERPRISE, INC.
Active
Other names
Life Turn Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNERINE M. WALLACE (OWNER CEO)
(336) 852-6006
Entity
Organization
Contact information
Practice address
116 PINEVIEW DR, REIDSVILLE, NC 27320-8126
(336) 342-4033
(336) 852-6701
Mailing address
PO BOX 1583, REIDSVILLE, NC 27323-1583
(336) 342-4033
(336) 852-6701
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL079092
NC
Other
Enumeration date
04/25/2008
Last updated
02/04/2010
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