Healthcare Provider Details

I. General information

NPI: 1851416523
Provider Name (Legal Business Name): JIREH PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SCOTCH CT
WOODBRIDGE VA
22191-4414
US

IV. Provider business mailing address

3125 WEEPING CHERRY CT
DUMFRIES VA
22026-4560
US

V. Phone/Fax

Practice location:
  • Phone: 703-680-0438
  • Fax: 703-221-2358
Mailing address:
  • Phone: 703-221-2354
  • Fax: 703-221-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number75502006
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number75501001
License Number StateVA

VIII. Authorized Official

Name: MRS. MARY E BELL
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 703-221-2354