Provider Demographics
NPI:1144861170
Name:KJLN INC.
Entity type:Organization
Organization Name:KJLN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-806-4418
Mailing Address - Street 1:4208 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2138
Mailing Address - Country:US
Mailing Address - Phone:276-806-4418
Mailing Address - Fax:
Practice Address - Street 1:110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2908
Practice Address - Country:US
Practice Address - Phone:757-529-8844
Practice Address - Fax:757-525-4927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KJLN INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-01
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health