1104554625 NPI number — VIRGINIA MISSION HEALTH ACQUISITION LLC

Table of content: (NPI 1104554625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104554625 NPI number — VIRGINIA MISSION HEALTH ACQUISITION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA MISSION HEALTH ACQUISITION 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:
Provider Other Organization Name Type Code:
6
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:
1104554625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30310 RANCHO VIEJO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-1576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7803 REBEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-348-9746
Provider Business Practice Location Address Fax Number:
949-579-2876
Provider Enumeration Date:
08/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
FARBMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
949-301-2863

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4531-01-003 . This is a "DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 578314 . This is a "THE JOINT COMMISSION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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