Most Relevant Information
Provider Data
| NPI Number: | 1003451873 |
| Provider Name: | PETRA JUA |
| Entity Type: | Individual |
| Taxonomy Code: | 320900000X |
| Specialty: | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/15/2019 |
| Last Updated: | 11/15/2019 |
Provider Practice Location
2205 16TH ST SE
WASHINGTON
DC
200204333
Practice Location Phone/Fax
| Phone: | 3013708049 |
| Fax: |
Provider Mailing Location
25 E WAYNE AVE # M706
SILVER SPRING
MD
209014264
Provider Mailing Phone/Fax
| Phone: | 3013708949 |
| Fax: |