Provider Demographics
NPI:1174122162
Name:JOTAVA
Entity type:Organization
Organization Name:JOTAVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:EJD, LCSW
Authorized Official - Phone:804-247-3195
Mailing Address - Street 1:16407 OTTERDALE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1556
Mailing Address - Country:US
Mailing Address - Phone:804-247-3195
Mailing Address - Fax:804-739-9370
Practice Address - Street 1:1607 TITANIUM AVENUE
Practice Address - Street 2:202
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-379-7186
Practice Address - Fax:804-379-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care