Jesus And Mary Church
Durable Medical Equipment & Medical Supplies in Woodbridge, VA. Organization (NPI-2).
NPI number1104767425
StatusActive
Last updated in NPPESApr 2, 2026
Details
- NPI
- 1104767425
- Entity type
- Organization (NPI-2)
- Legal business name
- Jesus And Mary Church
- Organization subpart
- No
- Enumeration date
- Apr 2, 2026
- Certification date
- Apr 2, 2026
- Last updated
- Apr 2, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | Yes |
Practice location
14970 Potomac Heights Pl Apt 113Woodbridge, VA 22191-6261
Phone 929-410-5754
Mailing address
14970 Potomac Heights Pl Apt 113Woodbridge, VA 22191-6261
Authorized official
Sergio Bolanos
Ceo
9294105754
Is something wrong?
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