Organization
JACKSON FEILD HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E CRANE (CHIEF FINANCIAL OFFICER)
(434) 634-3217
Entity
Organization
Contact information
Practice address
546 WALNUT GROVE DR, JARRATT, VA 23867-8611
(434) 634-3217
(434) 348-3471
Mailing address
546 WALNUT GROVE DR, JARRATT, VA 23867-8611
(434) 634-3217
(434) 348-3471
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
278-05
VA
1041C0700X
Clinical Social Worker
Primary
278-05
VA
320800000X
Mental Illness Community Based Residential Treatment Facility
1376-05-001
VA
363AM0700X
Medical Physician Assistant
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376-05-001
—
VA
Enumeration date
05/21/2008
Last updated
06/16/2011
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