NPI 1508663923

Jessie Mae's Supported Living, LLC

Organisation Assisted Living Facility (Behavioral Disturbances) Suffolk, VA

Practice location

Address: 614 Roosevelt Dr, Suffolk, VA 23434-3348
Phone: (757) 967-1062
Fax: (757) 801-5375
Mailing address: 23069 Retreat Ln, Carrollton, VA 23314-4192

Authorised official

Name: Lynnette Cross-Mack
Title: Owner
Phone: (757) 967-1062

Registered specialties

Assisted Living Facility (Behavioral Disturbances) Primary

Nursing & Custodial Care Facilities Taxonomy 3104A0630X

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Registry record

NPI: 1508663923
Entity type: Organization
NPI issued: 25 Feb 2025
Record last updated: 25 Feb 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.