Provider Demographics
NPI:1538922208
Name:JCM COMMUNITY WELLNESS LLC
Entity type:Organization
Organization Name:JCM COMMUNITY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-986-5787
Mailing Address - Street 1:8646 RESECA LANE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:804-986-5787
Mailing Address - Fax:
Practice Address - Street 1:8646 RESECA LANE
Practice Address - Street 2:
Practice Address - City:WEST SPRINFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1411
Practice Address - Country:US
Practice Address - Phone:804-986-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health