# JESSIE MAE'S SUPPORTED LIVING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508663923
- **Authorized official:** LYNNETTE CROSS-MACK RN (OWNER)
- **Authorized official phone:** (757) 967-1062

## Contact information

- **Practice address:** 614 ROOSEVELT DR, SUFFOLK, VA 23434-3348
- **Practice address phone:** (757) 967-1062
- **Practice address fax:** (757) 801-5375
- **Mailing address:** 23069 RETREAT LN, CARROLLTON, VA 23314-4192
- **Mailing address phone:** (757) 967-1062
- **Mailing address fax:** (757) 801-5375

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | Yes |

## Other

- **Enumeration date:** 02/25/2025
- **Last updated:** 02/25/2025