Provider Demographics
NPI:1497243349
Name:JIREH'S RESIDENTS HOME CARE LLC
Entity Type:Organization
Organization Name:JIREH'S RESIDENTS HOME CARE LLC
Other - Org Name:JRHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:RICHELIEU
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-819-0291
Mailing Address - Street 1:10304 AVENHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3690
Mailing Address - Country:US
Mailing Address - Phone:804-819-0219
Mailing Address - Fax:
Practice Address - Street 1:10304 AVENHAM WAY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-3690
Practice Address - Country:US
Practice Address - Phone:804-819-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care