Provider Demographics
NPI:1174645790
Name:MARTHA JEFFERSON HOUSE
Entity Type:Organization
Organization Name:MARTHA JEFFERSON HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARROTT
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, LNHA, CCC-SLP
Authorized Official - Phone:434-293-6136
Mailing Address - Street 1:1600 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-1918
Mailing Address - Country:US
Mailing Address - Phone:434-293-6136
Mailing Address - Fax:434-295-0400
Practice Address - Street 1:1600 GORDON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1918
Practice Address - Country:US
Practice Address - Phone:434-293-6136
Practice Address - Fax:434-295-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA000744310400000X
VANH2625313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility