Organization
JEANS REST HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LULA MCDONALD (OWNER ADMIN)
(910) 480-0020
Entity
Organization
Contact information
Practice address
114 UNIVERSITY AVE, FAYETTEVILLE, NC 28301-3440
(910) 480-0020
(910) 480-0020
Mailing address
114 UNIVERSITY AVE, FAYETTEVILLE, NC 28301-3440
(910) 480-0020
(910) 480-0020
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
FCL026029
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7802336
—
NC
Enumeration date
03/27/2007
Last updated
08/22/2020
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