Provider Demographics
NPI:1780136713
Name:JEN & C HOME CARE, LLC
Entity type:Organization
Organization Name:JEN & C HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-636-8899
Mailing Address - Street 1:1040 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7952
Mailing Address - Country:US
Mailing Address - Phone:757-636-8899
Mailing Address - Fax:757-498-4739
Practice Address - Street 1:905 ARAGONA BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5301
Practice Address - Country:US
Practice Address - Phone:757-636-8899
Practice Address - Fax:757-498-4739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1117-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities