1154356244 NPI number — FAIRFAX COUNTY, VIRGINIA

Table of content: (NPI 1154356244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154356244 NPI number — FAIRFAX COUNTY, VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRFAX COUNTY, VIRGINIA
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:
FAIRFAX-FALLS CHURCH COMMUNITY SERVICES BOARD
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:
1154356244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12011 GOVERNMENT CENTER PARKWAY
Provider Second Line Business Mailing Address:
SUITE 836
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-324-7000
Provider Business Mailing Address Fax Number:
703-653-6626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12011 GOVERNMENT CENTER PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 836
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-324-7000
Provider Business Practice Location Address Fax Number:
703-653-6626
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
703-324-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X , with the licence number: 113 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 222044 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010200229 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MHSS . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004945107 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010200270 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5700 . This is a "CAREFIRST BCBS NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008743126 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010200181 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541705851 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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