Provider Demographics
NPI:1114417946
Name:WMD JAMESTOWN OPERATOR, LLC
Entity Type:Organization
Organization Name:WMD JAMESTOWN OPERATOR, LLC
Other - Org Name:BERKELEY OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF MANAGEMENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-935-1992
Mailing Address - Street 1:4882 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1461
Mailing Address - Country:US
Mailing Address - Phone:815-935-1992
Mailing Address - Fax:815-935-8380
Practice Address - Street 1:1807 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2326
Practice Address - Country:US
Practice Address - Phone:757-941-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAALF1104623OtherASSISTED LIVING / MEMORY CARE COMMUNITY