Provider Demographics
NPI:1790332971
Name:JENNIFER FOUNDATION INC
Entity Type:Organization
Organization Name:JENNIFER FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-326-8780
Mailing Address - Street 1:8815 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-1132
Mailing Address - Country:US
Mailing Address - Phone:301-326-8780
Mailing Address - Fax:
Practice Address - Street 1:8815 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-1132
Practice Address - Country:US
Practice Address - Phone:301-326-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities