Provider Demographics
NPI:1962247064
Name:JO FIRST RESIDENTIAL SERVICE LLC
Entity type:Organization
Organization Name:JO FIRST RESIDENTIAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TILAYE
Authorized Official - Middle Name:KASSAHUN
Authorized Official - Last Name:ABATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-380-3504
Mailing Address - Street 1:1701 QUAIL COVEY RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3488
Mailing Address - Country:US
Mailing Address - Phone:804-380-3504
Mailing Address - Fax:804-380-3504
Practice Address - Street 1:10624 SARATA LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-7117
Practice Address - Country:US
Practice Address - Phone:804-380-3504
Practice Address - Fax:804-380-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances