Provider Demographics
NPI:1265699870
Name:JACKSON FEILD HOMES
Entity type:Organization
Organization Name:JACKSON FEILD HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-634-3217
Mailing Address - Street 1:546 WALNUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:JARRATT
Mailing Address - State:VA
Mailing Address - Zip Code:23867-8611
Mailing Address - Country:US
Mailing Address - Phone:434-634-3217
Mailing Address - Fax:434-348-3471
Practice Address - Street 1:546 WALNUT GROVE DR
Practice Address - Street 2:
Practice Address - City:JARRATT
Practice Address - State:VA
Practice Address - Zip Code:23867-8611
Practice Address - Country:US
Practice Address - Phone:434-634-3217
Practice Address - Fax:434-348-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA278-05101YP2500X, 1041C0700X
VA1376-05-001320800000X
VA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376-05-001Medicaid