Healthcare Provider Details

I. General information

NPI: 1720916174
Provider Name (Legal Business Name): JEM23,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WINE ST
HAMPTON VA
23669-4046
US

IV. Provider business mailing address

32 WINE ST
HAMPTON VA
23669-4046
US

V. Phone/Fax

Practice location:
  • Phone: 757-224-8879
  • Fax:
Mailing address:
  • Phone: 757-224-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELISHA MILLER
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 757-224-8879