Healthcare Provider Details

I. General information

NPI: 1558919886
Provider Name (Legal Business Name): J&C HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10329 DEMOCRACY LN STE B
FAIRFAX VA
22030-2559
US

IV. Provider business mailing address

25284 PLANTING FIELD DR
CHANTILLY VA
20152-4459
US

V. Phone/Fax

Practice location:
  • Phone: 703-682-2197
  • Fax:
Mailing address:
  • Phone: 203-823-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LEILING CHEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-682-2197