Provider Demographics
NPI:1740054287
Name:JUPITER HEALTH ORGANIZATION
Entity type:Organization
Organization Name:JUPITER HEALTH ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:SHERI
Authorized Official - Last Name:IRERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-459-7365
Mailing Address - Street 1:9006 LANCER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1707
Mailing Address - Country:US
Mailing Address - Phone:703-459-7365
Mailing Address - Fax:
Practice Address - Street 1:9345 LORTON MARKET STR
Practice Address - Street 2:UNIT 143
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079
Practice Address - Country:US
Practice Address - Phone:703-459-7365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty