Healthcare Provider Details

I. General information

NPI: 1093624819
Provider Name (Legal Business Name): JADE'S HEALING GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 WALMART WAY STE 14
MIDLOTHIAN VA
23113-2641
US

IV. Provider business mailing address

2741 WINTERBROOK CT
POWHATAN VA
23139-7838
US

V. Phone/Fax

Practice location:
  • Phone: 804-921-4611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY JADE BEASLEY
Title or Position: OWNER
Credential:
Phone: 180-000-0000