NPIMap

Organization Active NPI

John & Jennerine Enterprise, Inc

Doing business as Life Turn Community Support

  • Community/Behavioral Health Agency
  • Reidsville, NC
National Provider Identifier
1780882100
Registry record updated Feb 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JOHN & JENNERINE ENTERPRISE, INC
Doing business as
Life Turn Community Support
Practice address
1700 Roswell St
Reidsville, NC 27320-5721
Phone
(336) 342-5014
Fax
(336) 342-5012
NPI assigned
Jul 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2010

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

Authorized official

Name
Mrs. Jennerine Mickle Wallace
Title
Owner Executive Director
Phone
(336) 342-5014

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1700 Roswell St
Reidsville, NC 27320-5721

Mailing address

PO Box 1583
Reidsville, NC 27323-1583
Phone (336) 342-5014

Other names 1

  • Life Turn Community Support 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.

Locations

1700 Roswell St
Reidsville, NC 27320
Phone (336) 342-5014

NPI Registry JSON

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1780882100",
    "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": "336-342-5014",
            "fax_number": "336-342-5012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 ROSWELL ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273205721",
            "telephone_number": "336-342-5014",
            "fax_number": "336-342-5012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN & JENNERINE ENTERPRISE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-06",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JENNERINE",
        "authorized_official_middle_name": "MICKLE",
        "authorized_official_title_or_position": "OWNER EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-342-5014",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Turn Community Support",
            "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 1, 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.