1518092063 NPI number — J & S CARE INC.

Table of content: RENEA MARIE PALMER CRNA (NPI 1255386207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518092063 NPI number — J & S CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J & S CARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518092063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
941 GOINS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28372-8362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-521-0040
Provider Business Mailing Address Fax Number:
910-521-3266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
941 GOINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-8362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-0040
Provider Business Practice Location Address Fax Number:
910-521-3266
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUNT
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
LYNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-521-0040

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HAL-078-064 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7805607 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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