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NPI Code Detail

MEDICARE: JEREMIAH FOUNDATION INC

MEDICARE: JEREMIAH FOUNDATION INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
21041C0700XClinical Social Worker0904004489VA

General Provider Information

NPI Number : 1194030874
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEREMIAH FOUNDATION INC
Provider Business Mailing Address
First Line : PO BOX 4504
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23112-0010
Country : US
Telephone Number : 804-399-1993
Fax Number :
Provider Business Practice Location Address
First Line : 9513 HULL STREET RD STE A
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23236-1495
Country : US
Telephone Number : 804-608-9389
Fax Number : 804-763-3453
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JENNIFER ANN KELL
Credential : LCSW
Telephone Number : 804-608-9389
Provider Enumeration Date : 08/18/2010
Last Update Date : 01/05/2023

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