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General NPI Number Information
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NPI Number | 1093624819
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Entity Type | Organization
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Legal Business Name | JADE'S HEALING GROVE
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 2021 WALMART WAY STE 14
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-2641
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Country | US
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Telephone | 804-921-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 2741 WINTERBROOK CT
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City | POWHATAN
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State | VA
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Zip | 23139-7838
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY JADE BEASLEY
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Credential |
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Telephone | 804-921-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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