Provider Demographics
NPI:1700266277
Name:JAN'S RESIDENTIAL HOMES
Entity Type:Organization
Organization Name:JAN'S RESIDENTIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR/CNA
Authorized Official - Phone:434-430-0993
Mailing Address - Street 1:307 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-1421
Mailing Address - Country:US
Mailing Address - Phone:434-676-1372
Mailing Address - Fax:434-676-1062
Practice Address - Street 1:307 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1421
Practice Address - Country:US
Practice Address - Phone:434-676-1372
Practice Address - Fax:434-676-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-31
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA311ZA0620X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness