Provider Demographics
NPI:1942744073
Name:JT ALLEYNE ENTERPRISES LLC
Entity Type:Organization
Organization Name:JT ALLEYNE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYNESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:757-366-5423
Mailing Address - Street 1:3575 BRIDGE RD
Mailing Address - Street 2:SUITE 8 #253
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1800
Mailing Address - Country:US
Mailing Address - Phone:757-528-8337
Mailing Address - Fax:
Practice Address - Street 1:621 STONEY CREEK LN
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-0064
Practice Address - Country:US
Practice Address - Phone:757-528-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service