Healthcare Provider Details

I. General information

NPI: 1285568147
Provider Name (Legal Business Name): JUANITA JABLASONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SIRIUS DR
BEAR DE
19701-6859
US

IV. Provider business mailing address

106 SIRIUS DR
BEAR DE
19701-6859
US

V. Phone/Fax

Practice location:
  • Phone: 202-989-8130
  • Fax:
Mailing address:
  • Phone: 202-989-8130
  • Fax: 202-989-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: