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General NPI Number Information
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NPI Number | 1780136713
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Entity Type | Organization
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Legal Business Name | JEN & C HOME CARE, LLC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 905 ARAGONA BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5301
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Country | US
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Telephone | 757-636-8899
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Fax | 757-498-4739
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Provider Business Mailing Address
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Address Line | 1040 NORTHWOOD DR
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City | VA BEACH
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State | VA
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Zip | 23452-7952
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Country | US
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Telephone | 757-636-8899
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Fax | 757-498-4739
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOSEFINA GALON
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Credential |
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Telephone | 757-636-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 1117-01-001
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License Number State | VA
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