Provider Demographics
NPI:1932506961
Name:CALVIN JAYNE CONSTRUCTION SERVICES LLC
Entity Type:Organization
Organization Name:CALVIN JAYNE CONSTRUCTION SERVICES LLC
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MEMBER
Authorized Official - Phone:804-550-8675
Mailing Address - Street 1:6688 TATUM RD
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842-6902
Mailing Address - Country:US
Mailing Address - Phone:804-550-8675
Mailing Address - Fax:
Practice Address - Street 1:6688 TATUM RD
Practice Address - Street 2:
Practice Address - City:DISPUTANTA
Practice Address - State:VA
Practice Address - Zip Code:23842-6902
Practice Address - Country:US
Practice Address - Phone:804-550-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705135545332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2705135545OtherENVIRONMENTAL MODIFICATIONS