1407004278 NPI number — ARDEN COURTS-FAIR OAKS OF FAIRFAX VA LLC

Table of content: (NPI 1407004278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407004278 NPI number — ARDEN COURTS-FAIR OAKS OF FAIRFAX VA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARDEN COURTS-FAIR OAKS OF FAIRFAX VA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARDEN COURTS OF FAIR OAKS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407004278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N SUMMIT ST
Provider Second Line Business Mailing Address:
ATTN BARRY A LAZARUS
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-252-5541
Provider Business Mailing Address Fax Number:
419-254-5494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12469 LEE JACKSON MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-383-0060
Provider Business Practice Location Address Fax Number:
703-383-1237
Provider Enumeration Date:
09/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAZARUS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT - REIMBURSEMENT
Authorized Official Telephone Number:
419-252-5541

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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