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General NPI Number Information
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NPI Number | 1689299851
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Entity Type | Organization
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Legal Business Name | J WALLER 71 INC.
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 102 CHURCH AVE
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City | LOUISA
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State | VA
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Zip | 23093
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Country | US
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Telephone | 540-684-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 816 N LAKESHORE DR
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City | LOUISA
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State | VA
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Zip | 23093-7020
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Country | US
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Telephone | 540-894-6349
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JESSICA ANN WALLER
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Credential | RN
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Telephone | 540-684-2474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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