Provider Demographics
NPI:1275072993
Name:CALVIN JAYNE QUALITY LIVING, LLC
Entity Type:Organization
Organization Name:CALVIN JAYNE QUALITY LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING 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:
Authorized Official - Phone:804-550-8674
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:804-550-8674
Mailing Address - Fax:804-251-1299
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:804-550-8674
Practice Address - Fax:804-251-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2182-01-002320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities