Provider Demographics
NPI:1285950923
Name:JC&G GROUP HOMES, LLC
Entity type:Organization
Organization Name:JC&G GROUP HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SELVYN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-682-5130
Mailing Address - Street 1:400 E SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-3108
Mailing Address - Country:US
Mailing Address - Phone:336-682-5130
Mailing Address - Fax:336-499-2634
Practice Address - Street 1:400 E SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3108
Practice Address - Country:US
Practice Address - Phone:336-682-5130
Practice Address - Fax:336-499-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children