MEDICARE: JDL HEALTHCARE SERVICES, INC DBA AMADA SENIOR CARE RICHMOND WEST

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
1	253Z00000X	In Home Supportive Care Agency	HCO151287	VA

General Provider Information

NPI Number	:	1316397870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JDL HEALTHCARE SERVICES, INC DBA AMADA SENIOR CARE RICHMOND WEST

Provider Business Mailing Address
First Line	:	6800 PARAGON PL
Second Line	:	SUITE 106
City	:	RICHMOND
State	:	VA
Zip	:	23230-1649
Country	:	US
Telephone Number	:	804-793-8255
Fax Number	:	804-793-8266

Provider Business Practice Location Address
First Line	:	6800 PARAGON PL
Second Line	:	SUITE 106
City	:	RICHMOND
State	:	VA
Zip	:	23230-1649
Country	:	US
Telephone Number	:	804-793-8255
Fax Number	:	804-793-8266

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. JAY LAWRENCE MANN
Credential	:
Telephone Number	:	804-793-8255

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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