Healthcare Provider Details

I. General information

NPI: 1760653042
Provider Name (Legal Business Name): JEWISH FOUNDATION FOR GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 DEVERE DR
SILVER SPRING MD
20903-1622
US

IV. Provider business mailing address

1500 E JEFFERSON ST
ROCKVILLE MD
20852-1501
US

V. Phone/Fax

Practice location:
  • Phone: 301-984-3839
  • Fax: 301-576-5619
Mailing address:
  • Phone: 301-984-3839
  • Fax: 301-576-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberDDA-19977-07
License Number StateMD

VIII. Authorized Official

Name: MS. MICHELE LIZEAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-984-3839