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General NPI Number Information
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NPI Number | 1073202909
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Entity Type | Organization
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Legal Business Name | JUMP START HOME CARE, LLC
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 5373 ARISTOCRAT DR
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City | PROVIDENCE FORGE
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State | VA
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Zip | 23140-4443
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Country | US
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Telephone | 804-557-5255
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Fax | 804-557-5255
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Provider Business Mailing Address
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Address Line | 5373 ARISTOCRAT DR
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City | PROVIDENCE FORGE
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State | VA
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Zip | 23140-4443
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Country | US
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Telephone | 804-557-5255
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Fax | 804-557-5255
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. DANIEL FEIVOR
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Credential |
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Telephone | 804-557-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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