NPIMap

Organization Active NPI

John & Jennerine Enterprise, Inc.

Doing business as Life Turn Group Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Reidsville, NC
National Provider Identifier
1700051273
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL079092 Issued in NC
Legal business name
JOHN & JENNERINE ENTERPRISE, INC.
Doing business as
Life Turn Group Home
Practice address
116 Pineview Dr
Reidsville, NC 27320-8126
Phone
(336) 342-4033
Fax
(336) 852-6701
NPI assigned
Apr 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Authorized official

Name
Mrs. Jennerine M. Wallace
Title
Owner Ceo
Phone
(336) 852-6006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL079092 NC Primary

Addresses

Primary practice location

116 Pineview Dr
Reidsville, NC 27320-8126

Mailing address

PO Box 1583
Reidsville, NC 27323-1583
Phone (336) 342-4033

Other names 1

  • Life Turn Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
John Jennerine Enterprise Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1700051273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1583",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273231583",
            "telephone_number": "336-342-4033",
            "fax_number": "336-852-6701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 PINEVIEW DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273208126",
            "telephone_number": "336-342-4033",
            "fax_number": "336-852-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN & JENNERINE ENTERPRISE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JENNERINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "336-852-6006",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL079092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Turn Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.