# J K M EXTENDED HOMEHEALTH

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

## Provider details

- **NPI number:** 1528831310
- **Authorized official:** JAMAR M BIVINS (PRESIDENT)
- **Authorized official phone:** (757) 338-0803

## Contact information

- **Practice address:** 320 BEN ST, SUFFOLK, VA 23434-3106
- **Practice address phone:** (757) 338-0803
- **Mailing address:** 320 BEN ST, SUFFOLK, VA 23434-3106
- **Mailing address phone:** (757) 338-0803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/02/2023
- **Last updated:** 11/02/2023