Jackson Professional Serv Llc

LBN: Jackson Professional Serv Llc
Jackson Professional Serv Llc is an health care organization with primary practice located at 420 Pine Ridge Rd , Petersburg VA 23805-1320. The organization recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Other Service Providers / Community Health Worker, Agencies / Community/Behavioral Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is the primary health care specialty. Jackson Professional Serv Llc can be contacted via phone (804) 714-5998, or through Stokes, Antoinita C via phone (804) 613-0087.

Contact Information

Primary practice address
420 Pine Ridge Rd Petersburg VA 23805-1320
Phone: (804) 714-5998
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Stokes, Antoinita C
Phone: (804) 613-0087

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Other Service Providers / Community Health Worker 172V00000X
Agencies / Community/Behavioral Health 251S00000X
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X

Profile Details

NPI number 1922761352
LBN Legal business name Jackson Professional Serv Llc
DBA Doing business as
Authorized official Stokes, Antoinita C
Entity Organization
Organization subpart 1 No
Enumeration date Oct 21st, 2021
Last updated Oct 21st, 2021 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922761352 NPPES
Virginia MEDICAID 0709024300
Virginia Other 0733006270
Virginia MEDICAID 0733006270
Virginia Other 0709024300
Virginia Other 0732008263

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