Provider Demographics
NPI:1891188553
Name:JAKAFI BEHAVIORAL CARE CENTER, LLC
Entity type:Organization
Organization Name:JAKAFI BEHAVIORAL CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KWADWO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANYANE-NTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-491-2436
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 MAIFIELD AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23890-5000
Practice Address - Country:US
Practice Address - Phone:804-834-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management