Healthcare Provider Details

I. General information

NPI: 1346197076
Provider Name (Legal Business Name): JEANETTES HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CARROLL WALK AVE
FREDERICK MD
21701-6943
US

IV. Provider business mailing address

22108 WINDING WOODS WAY
CLARKSBURG MD
20871-6366
US

V. Phone/Fax

Practice location:
  • Phone: 240-936-0993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ADELAIDE ABANKWAH
Title or Position: DIRECTOR
Credential:
Phone: 301-765-4798