Provider Demographics
NPI:1871806869
Name:J-JIREH SERVICES
Entity type:Organization
Organization Name:J-JIREH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERTIE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:CRUTE
Authorized Official - Suffix:
Authorized Official - Credentials:QP, LPN
Authorized Official - Phone:252-433-5103
Mailing Address - Street 1:188 SHOCCO SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-8715
Mailing Address - Country:US
Mailing Address - Phone:252-257-9909
Mailing Address - Fax:
Practice Address - Street 1:188 SHOCCO SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-8715
Practice Address - Country:US
Practice Address - Phone:252-257-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1097604251B00000X, 251C00000X, 253Z00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle