Provider Demographics
NPI:1699208215
Name:TJC FAMILY SUPPORT LLC
Entity type:Organization
Organization Name:TJC FAMILY SUPPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYEI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-289-8820
Mailing Address - Street 1:1500 E LITTLE CREEK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4137
Mailing Address - Country:US
Mailing Address - Phone:757-965-9137
Mailing Address - Fax:844-929-0611
Practice Address - Street 1:1500 E LITTLE CREEK RD STE 306
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-965-9137
Practice Address - Fax:844-929-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant