=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902039217
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JC'S HOME IMPROVEMENTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2009
-----------------------------------------------------
Last Update Date | 09/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2172 REVEREND COLEMAN RD
-----------------------------------------------------
City | CLOVER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24534-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-579-1419
-----------------------------------------------------
Fax | 434-454-6343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2172 REVEREND COLEMAN RD
-----------------------------------------------------
City | CLOVER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24534-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-579-1419
-----------------------------------------------------
Fax | 434-454-6343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WILLIAM JUNIOR CREWS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-579-1419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number | 2705116595
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------