Provider Demographics
NPI:1598860488
Name:JDM OF VA LLC
Entity Type:Organization
Organization Name:JDM OF VA LLC
Other - Org Name:DBAADULT DAY SERVICES OF SOUTH RICHMOND
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERKELEY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:804-788-1956
Mailing Address - Street 1:7 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5601
Mailing Address - Country:US
Mailing Address - Phone:804-788-1956
Mailing Address - Fax:804-788-1940
Practice Address - Street 1:6201 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5809
Practice Address - Country:US
Practice Address - Phone:804-674-1600
Practice Address - Fax:804-674-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA52402006305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization