Provider Demographics
NPI:1245520717
Name:JK2C, LLC
Entity type:Organization
Organization Name:JK2C, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CHINNICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-774-0033
Mailing Address - Street 1:6105 KENT CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3107
Mailing Address - Country:US
Mailing Address - Phone:757-774-0033
Mailing Address - Fax:757-394-3094
Practice Address - Street 1:109 WIMBLEDON SQ
Practice Address - Street 2:UNIT H
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4945
Practice Address - Country:US
Practice Address - Phone:757-774-0033
Practice Address - Fax:757-394-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone