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General NPI Number Information
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NPI Number | 1417493917
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Entity Type | Organization
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Legal Business Name | JD ENTERPRISE RESOURCES LLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 10375 DEMOCRACY LN STE A
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City | FAIRFAX
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State | VA
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Zip | 22030-2554
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Country | US
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Telephone | 703-940-1515
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Fax | 703-940-1516
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Provider Business Mailing Address
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Address Line | 10375 DEMOCRACY LN STE A
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City | FAIRFAX
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State | VA
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Zip | 22030-2554
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Country | US
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Telephone | 703-940-1515
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Fax | 703-940-1516
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY FLETCHER
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Credential |
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Telephone | 703-940-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCO-171200
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License Number State | VA
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