Wolfe & Jackson Group Home, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL 034-254 Issued in NC

Legal business name

WOLFE & JACKSON GROUP HOME, INC.

Practice address

3913 Indiana Ave
Winston Salem, NC 27105-3410

Phone

(336) 661-0923

Fax

(336) 793-1496

NPI assigned

Apr 20, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Zelma Jackson- Wolfe

Title

Executive Director

Phone

(336) 749-7660

Specialties & licenses 2

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Wolfe Jackson Group Home Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wolfe & Jackson Group Home, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Winston Salem, NC
  • NPI 1790016517
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1265758916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4912",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271154912",
            "telephone_number": "336-245-0303",
            "fax_number": "336-722-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3913 INDIANA AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271053410",
            "telephone_number": "336-661-0923",
            "fax_number": "336-793-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLFE & JACKSON GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "WOLFE",
        "authorized_official_first_name": "ZELMA",
        "authorized_official_middle_name": "JACKSON-",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-749-7660",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL 034-254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3419271",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Ann Wolf, BT
• Ryan Michael Wolf, M.D.
• Wolfe & Jackson Family Care Home
• Wolfe & Jackson Family Care Home
• Wolfe & Jackson Group Home, Inc
• April B. Wolfe, OTR/L
• Emily Wolfe, MSW, LCSW-A
• Jessica Wolfe
• John R Wolfe, MD
• Rachel Mathilda Wolfe, M.D.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.