Jessie Mae'S Supported Living, LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

JESSIE MAE'S SUPPORTED LIVING, LLC

Practice address

614 Roosevelt Dr
Suffolk, VA 23434-3348

Phone

(757) 967-1062

Fax

(757) 801-5375

NPI assigned

Feb 25, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lynnette Cross-Mack, RN

Title

Owner

Phone

(757) 967-1062

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1508663923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23069 RETREAT LN",
            "city": "CARROLLTON",
            "state": "VA",
            "postal_code": "233144192",
            "telephone_number": "757-967-1062",
            "fax_number": "757-801-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 ROOSEVELT DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234343348",
            "telephone_number": "757-967-1062",
            "fax_number": "757-801-5375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE MAE'S SUPPORTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-25",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "CROSS-MACK",
        "authorized_official_first_name": "LYNNETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-967-1062",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Behavioral Disturbances) in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Assisted Living Facility (Behavioral Disturbances) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.