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General NPI Number Information
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NPI Number | 1174645790
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Entity Type | Organization
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Legal Business Name | MARTHA JEFFERSON HOUSE
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1600 GORDON AVE
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-1918
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Country | US
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Telephone | 434-293-6136
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Fax | 434-295-0400
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Provider Business Mailing Address
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Address Line | 1600 GORDON AVE
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-1918
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Country | US
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Telephone | 434-293-6136
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Fax | 434-295-0400
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HEATHER PARROTT
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Credential | DHSC, LNHA, CCC-SLP
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Telephone | 434-293-6136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH2625
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 000744
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License Number State | VA
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