Provider Demographics
NPI:1205229333
Name:JONES BRANCH LLC
Entity Type:Organization
Organization Name:JONES BRANCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:ND, PHD
Authorized Official - Phone:703-937-7169
Mailing Address - Street 1:7921 JONES BRANCH DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3306
Mailing Address - Country:US
Mailing Address - Phone:703-444-9141
Mailing Address - Fax:
Practice Address - Street 1:7921 JONES BRANCH DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3306
Practice Address - Country:US
Practice Address - Phone:703-444-9141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1515261QR0405X
VA49D2044687291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory