Healthcare Provider Details

I. General information

NPI: 1063799807
Provider Name (Legal Business Name): JC HOMELIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 IRON BRIDGE RD
NORTH CHESTERFIELD VA
23234-5923
US

IV. Provider business mailing address

PO BOX 1600
CHESTERFIELD VA
23832-9125
US

V. Phone/Fax

Practice location:
  • Phone: 804-869-6155
  • Fax: 804-714-1356
Mailing address:
  • Phone: 804-869-6155
  • Fax: 804-714-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1447-01-011
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN NETTO
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-869-6155