Healthcare Provider Details

I. General information

NPI: 1033008461
Provider Name (Legal Business Name): THREE FINGER JACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10432 BALLS FORD RD STE 300
MANASSAS VA
20109-2517
US

IV. Provider business mailing address

10432 BALLS FORD RD STE 300
MANASSAS VA
20109-2517
US

V. Phone/Fax

Practice location:
  • Phone: 703-936-5545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN MCBROOM
Title or Position: OWNER OPERATOR
Credential:
Phone: 540-424-3991