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General NPI Number Information
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NPI Number | 1427355304
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Entity Type | Organization
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Legal Business Name | JL SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 1907 LAZENBURY RD
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City | BEDFORD
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State | VA
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Zip | 24523-6224
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Country | US
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Telephone | 540-587-0156
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Fax | 540-587-0156
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Provider Business Mailing Address
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Address Line | 1907 LAZENBURY RD
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City | BEDFORD
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State | VA
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Zip | 24523-6224
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Country | US
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Telephone | 540-587-0156
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Fax | 540-587-0156
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. JULI LARSON
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Credential |
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Telephone | 540-587-0156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1552-03-001
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License Number State | VA
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