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General NPI Number Information
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NPI Number | 1205140100
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Entity Type | Organization
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Legal Business Name | JILL'S HOUSE INC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 9011 LEESBURG PIKE
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City | VIENNA
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State | VA
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Zip | 22182-1722
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Country | US
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Telephone | 703-639-5662
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9104
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City | MC LEAN
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State | VA
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Zip | 22102-0104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | MRS. MARY LEIDY
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Credential |
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Telephone | 703-639-5667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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