Provider Demographics
NPI:1821234337
Name:JEN & C HOME CARE,LLC
Entity Type:Organization
Organization Name:JEN & C HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NARCISA
Authorized Official - Middle Name:BLANCAFLOR
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:757-650-0673
Mailing Address - Street 1:905 ARAGONA BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5301
Mailing Address - Country:US
Mailing Address - Phone:757-650-0673
Mailing Address - Fax:757-333-3874
Practice Address - Street 1:905 ARAGONA BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5301
Practice Address - Country:US
Practice Address - Phone:757-275-9541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305R00000X
VA1117305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
0156459460OtherAPI