Provider Demographics
NPI:1376611095
Name:JEWISH FOUNDATION FOR GROUP HOMES
Entity Type:Organization
Organization Name:JEWISH FOUNDATION FOR GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-984-3839
Mailing Address - Street 1:6010 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3809
Mailing Address - Country:US
Mailing Address - Phone:301-984-3839
Mailing Address - Fax:301-984-4219
Practice Address - Street 1:2511 FREETOWN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-2513
Practice Address - Country:US
Practice Address - Phone:703-453-0445
Practice Address - Fax:703-453-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA317-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities