Provider Demographics
NPI:1689490096
Name:PROVIDERS INC LLC
Entity type:Organization
Organization Name:PROVIDERS INC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JATAI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-439-3667
Mailing Address - Street 1:15022 SUNNY RIDGE CT APT 203
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3967
Mailing Address - Country:US
Mailing Address - Phone:202-439-3667
Mailing Address - Fax:
Practice Address - Street 1:15022 SUNNY RIDGE CT APT 203
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3967
Practice Address - Country:US
Practice Address - Phone:202-439-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care