NPIMap

Organization Active NPI

JMJ Enterprise, LLC

Doing business as Fresh Start Home for Children

  • Developmentally Disabled Services Day Training Agency
  • Greensboro, NC
National Provider Identifier
1366673105
Registry record updated Feb 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
MHL-041-857 Issued in NC
Legal business name
JMJ ENTERPRISE, LLC
Doing business as
Fresh Start Home for Children
Practice address
2020 Textile Dr
Greensboro, NC 27405-5857
Phone
(336) 271-6982
Fax
(336) 271-6982
NPI assigned
Jul 28, 2009
Last updated
Feb 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2010

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

Authorized official

Name
Mrs. Traci Deronn Martin
Title
Owner / Executive Director
Phone
(336) 271-6982

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MHL-041-857 NC Primary

Addresses

Primary practice location

2020 Textile Dr
Greensboro, NC 27405-5857

Mailing address

2020 Textile Dr
Greensboro, NC 27405-5857
Phone (336) 271-6982

Other names 1

  • Fresh Start Home for Children Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fresh Start Home for Children5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2020 Textile Dr
Greensboro, NC 27405
Phone (336) 271-6982

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266278400000",
    "number": "1366673105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 TEXTILE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055857",
            "telephone_number": "336-271-6982",
            "fax_number": "336-271-6982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 TEXTILE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055857",
            "telephone_number": "336-271-6982",
            "fax_number": "336-271-6982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JMJ ENTERPRISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2010-02-16",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "DERONN",
        "authorized_official_title_or_position": "OWNER / EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-271-6982",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "MHL-041-857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresh Start Home for Children",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.