1720444839 NPI number — MS. VERNEEKY CARENDA JACKSON PERSONAL CARE AIDE

Table of content: MS. VERNEEKY CARENDA JACKSON PERSONAL CARE AIDE (NPI 1720444839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720444839 NPI number — MS. VERNEEKY CARENDA JACKSON PERSONAL CARE AIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
VERNEEKY
Provider Middle Name:
CARENDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PERSONAL CARE AIDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720444839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4407 SPRENKLE LN APT C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23228-3580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-502-5897
Provider Business Mailing Address Fax Number:
804-501-5274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8260 ATLEE ROAD
Provider Second Line Business Practice Location Address:
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23116-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-764-6000
Provider Business Practice Location Address Fax Number:
804-764-6324
Provider Enumeration Date:
01/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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