Provider Demographics
NPI:1649428962
Name:JEFFERSON AREA CHIP, INC.
Entity type:Organization
Organization Name:JEFFERSON AREA CHIP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-964-4701
Mailing Address - Street 1:1469 GREENBRIER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1697
Mailing Address - Country:US
Mailing Address - Phone:434-964-4702
Mailing Address - Fax:434-964-4774
Practice Address - Street 1:1469 GREENBRIER PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1697
Practice Address - Country:US
Practice Address - Phone:434-964-4702
Practice Address - Fax:434-964-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management