Organization
KJLN INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS MOYER (CEO)
(276) 806-4418
Entity
Organization
Contact information
Practice address
4020 PORTSMOUTH BLVD, CHESAPEAKE, VA 23321-2126
(757) 529-8844
(757) 525-4927
Mailing address
4208 HELEN ST, SUFFOLK, VA 23435-2138
(276) 806-4418
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3316
—
VA
Enumeration date
08/05/2019
Last updated
02/20/2023
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