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General NPI Number Information
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NPI Number | 1700266277
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Entity Type | Organization
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Legal Business Name | JAN'S RESIDENTIAL HOMES
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Dates
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Enumeration Date | 05/31/2015
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Last Update Date | 05/31/2015
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Provider Practice Location Address
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Address Line | 307 N HIGH ST
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City | BLACKSTONE
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State | VA
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Zip | 23824-1421
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Country | US
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Telephone | 434-676-1372
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Fax | 434-676-1062
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Provider Business Mailing Address
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Address Line | 307 N HIGH ST
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City | BLACKSTONE
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State | VA
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Zip | 23824-1421
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Country | US
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Telephone | 434-676-1372
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Fax | 434-676-1062
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JUDY BENNETT
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Credential | ADMINISTRATOR/CNA
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Telephone | 434-430-0993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | VA
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