Organization
RESET RESIDENTIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JA'VAN JEFFERSON (MANAGING/ MEMBER)
(571) 830-9256
Entity
Organization
Contact information
Practice address
1137 NORMANDALE AVE W, PETERSBURG, VA 23803-7921
(571) 830-9256
Mailing address
1137 NORMANDALE AVE W, PETERSBURG, VA 23803-7921
(571) 830-9256
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
01/04/2025
Last updated
01/04/2025
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