Organization
JIREH'S PLACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD PHILLIP VANDERSHORST (EXECUTIVE DIRECTOR)
(704) 535-5590
Entity
Organization
Contact information
Practice address
5128 ROSEMEDE DR, CHARLOTTE, NC 28227-3011
(704) 535-5590
Mailing address
5128 ROSEMEDE DR, CHARLOTTE, NC 28227-3011
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408050
—
NC
Enumeration date
02/28/2007
Last updated
08/22/2020
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