Provider Demographics
NPI:1073202909
Name:JUMP START HOME CARE, LLC
Entity Type:Organization
Organization Name:JUMP START HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIVOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-557-5255
Mailing Address - Street 1:5373 ARISTOCRAT DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-4443
Mailing Address - Country:US
Mailing Address - Phone:804-557-5255
Mailing Address - Fax:804-557-5255
Practice Address - Street 1:5373 ARISTOCRAT DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-4443
Practice Address - Country:US
Practice Address - Phone:804-557-5255
Practice Address - Fax:804-557-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty