Organization
PROVIDERS INC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JATAI L JACKSON (CEO/DIRECTOR)
(202) 439-3667
Entity
Organization
Contact information
Practice address
15022 SUNNY RIDGE CT APT 203, WOODBRIDGE, VA 22191-3967
(202) 439-3667
Mailing address
15022 SUNNY RIDGE CT APT 203, WOODBRIDGE, VA 22191-3967
(202) 439-3667
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
12/02/2024
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