Provider Demographics
NPI:1093411928
Name:JUMPSTART RESIDENTIAL SERVICES INC
Entity Type:Organization
Organization Name:JUMPSTART RESIDENTIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-368-5640
Mailing Address - Street 1:1618 KIRKGATE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3248
Mailing Address - Country:US
Mailing Address - Phone:804-368-5640
Mailing Address - Fax:804-895-7914
Practice Address - Street 1:1618 KIRKGATE LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3248
Practice Address - Country:US
Practice Address - Phone:804-368-5640
Practice Address - Fax:804-895-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility