Organization
JESSIE MAE'S SUPPORTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNNETTE CROSS-MACK RN (OWNER)
(757) 967-1062
Entity
Organization
Contact information
Practice address
614 ROOSEVELT DR, SUFFOLK, VA 23434-3348
(757) 967-1062
(757) 801-5375
Mailing address
23069 RETREAT LN, CARROLLTON, VA 23314-4192
(757) 967-1062
(757) 801-5375
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
02/25/2025
Last updated
02/25/2025
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