Provider Demographics
NPI:1942032594
Name:JJD LEARNING ACADEMY
Entity type:Organization
Organization Name:JJD LEARNING ACADEMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-772-2991
Mailing Address - Street 1:2504 RAEFORD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5135
Mailing Address - Country:US
Mailing Address - Phone:910-916-3261
Mailing Address - Fax:
Practice Address - Street 1:2504 RAEFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5135
Practice Address - Country:US
Practice Address - Phone:910-916-3261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JJD LEARNING ACADEMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-14
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center