Jeans Rest Home

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

License

FCL026029 Issued in NC

Legal business name

JEANS REST HOME

Practice address

114 University Ave
Fayetteville, NC 28301-3440

Phone

(910) 480-0020

Fax

(910) 480-0020

NPI assigned

Mar 27, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lula McDonald

Title

Owner Admin

Phone

(910) 480-0020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942328695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 UNIVERSITY AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013440",
            "telephone_number": "910-480-0020",
            "fax_number": "910-480-0020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 UNIVERSITY AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013440",
            "telephone_number": "910-480-0020",
            "fax_number": "910-480-0020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANS REST HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "LULA",
        "authorized_official_title_or_position": "OWNER ADMIN",
        "authorized_official_telephone_number": "910-480-0020"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NC",
            "license": "FCL026029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802336",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Liam Jaussen, PA-C
• Rayyanoor Jawad, DO
• Suriya Bandara Jayawardena, MD
• JBV Anesthesiology Associates, PLLC
• Samille Jean-Pierre, MD
• Sriuma Jearanai, PHARM.D.
• Amber Michelle Jefferson, PHARMD
• Bryana Jefferson
• Tikela Jefferson
• Dorothy Marie Jeffries, P-LCSW

• Developmental Disabilities Clinic/Center in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Developmental Disabilities Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.