Provider Demographics
NPI:1427355304
Name:JL SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:JL SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULI
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-587-0156
Mailing Address - Street 1:1907 LAZENBURY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-6224
Mailing Address - Country:US
Mailing Address - Phone:540-587-0156
Mailing Address - Fax:540-587-0156
Practice Address - Street 1:1907 LAZENBURY RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-6224
Practice Address - Country:US
Practice Address - Phone:540-587-0156
Practice Address - Fax:540-587-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1552-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health