Provider Demographics
NPI:1285162529
Name:JWH SERVICE PARTNERS, INC
Entity type:Organization
Organization Name:JWH SERVICE PARTNERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-245-0123
Mailing Address - Street 1:4480 VALNORTH DR STE D
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6818
Mailing Address - Country:US
Mailing Address - Phone:229-245-0123
Mailing Address - Fax:229-247-8142
Practice Address - Street 1:4480 VALNORTH DR STE D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6818
Practice Address - Country:US
Practice Address - Phone:229-245-0123
Practice Address - Fax:229-247-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-R-0013385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care