Organization
JOHN & JENNERINE ENTERPRISE, INC
Active
Other names
Life Turn Community Support
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNERINE MICKLE WALLACE (OWNER EXECUTIVE DIRECTOR)
(336) 342-5014
Entity
Organization
Contact information
Practice address
1700 ROSWELL ST, REIDSVILLE, NC 27320-5721
(336) 342-5014
(336) 342-5012
Mailing address
PO BOX 1583, REIDSVILLE, NC 27323-1583
(336) 342-5014
(336) 342-5012
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/06/2007
Last updated
02/01/2010
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