MEDICARE: JACKSON-FEILD HOMES

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1356593693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON-FEILD HOMES

Provider Business Mailing Address
First Line	:	205 NORTH BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4006
Country	:	US
Telephone Number	:	804-355-8735
Fax Number	:	434-348-3471

Provider Business Practice Location Address
First Line	:	205 NORTH BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4006
Country	:	US
Telephone Number	:	804-355-8735
Fax Number	:	434-348-3471

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TRICIA DELANO
Credential	:
Telephone Number	:	804-355-8735

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	11/06/2008

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