Provider Demographics
NPI:1518100544
Name:MS. JANE'S PROFESSINAL CENTER
Entity type:Organization
Organization Name:MS. JANE'S PROFESSINAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-733-5166
Mailing Address - Street 1:525 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8099
Mailing Address - Country:US
Mailing Address - Phone:910-733-5166
Mailing Address - Fax:910-521-7435
Practice Address - Street 1:525 WOODS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8099
Practice Address - Country:US
Practice Address - Phone:910-733-5166
Practice Address - Fax:910-521-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC078223320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness