Healthcare Provider Details

I. General information

NPI: 1831945385
Provider Name (Legal Business Name): JAH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E MAIN ST
RICHMOND VA
23223-7069
US

IV. Provider business mailing address

PO BOX 981
YORKTOWN VA
23692-0981
US

V. Phone/Fax

Practice location:
  • Phone: 757-296-0432
  • Fax:
Mailing address:
  • Phone: 757-296-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDY TUPPONCE
Title or Position: CEO
Credential: RN
Phone: 757-296-0432