Provider Demographics
NPI:1639988678
Name:RESET RESIDENTIAL
Entity type:Organization
Organization Name:RESET RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JA'VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-830-9256
Mailing Address - Street 1:1137 NORMANDALE AVE W
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-7921
Mailing Address - Country:US
Mailing Address - Phone:571-830-9256
Mailing Address - Fax:
Practice Address - Street 1:1137 NORMANDALE AVE W
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-7921
Practice Address - Country:US
Practice Address - Phone:571-830-9256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility