Healthcare Provider Details

I. General information

NPI: 1043077670
Provider Name (Legal Business Name): MISS JADA MEREDITH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 WINDSOR CASTLE DR APT H
NEWPORT NEWS VA
23608-1963
US

IV. Provider business mailing address

153 WINDSOR CASTLE DR APT H
NEWPORT NEWS VA
23608-1963
US

V. Phone/Fax

Practice location:
  • Phone: 757-510-2469
  • Fax: 757-527-2275
Mailing address:
  • Phone: 757-510-2469
  • Fax: 757-527-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: JADA MEREDITH
Title or Position: MANAGER, OWNER
Credential:
Phone: 757-510-2469