Healthcare Provider Details

I. General information

NPI: 1316194699
Provider Name (Legal Business Name): PROJECT MEND-A-HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 TECHNOLOGY DRIVE
MANASSAS VA
20110
US

IV. Provider business mailing address

9500 TECHNOLOGY DRIVE
MANASSAS VA
20110
US

V. Phone/Fax

Practice location:
  • Phone: 703-792-7663
  • Fax: 703-792-7663
Mailing address:
  • Phone: 703-792-7663
  • Fax: 703-792-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SCHOCK-BOLLES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-792-7663