Organization
JILL'S HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LEIDY (CHIEF ADMINISTRATIVE OFFICER)
(703) 639-5667
Entity
Organization
Contact information
Practice address
9011 LEESBURG PIKE, VIENNA, VA 22182-1722
(703) 639-5662
Mailing address
PO BOX 9104, MC LEAN, VA 22102-0104
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
08/03/2010
Last updated
08/03/2010
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