1477897445 NPI number — FAIRFAX PSYCHIATRY & BEHAVIORAL HEALTH CO.

Table of content: (NPI 1477897445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477897445 NPI number — FAIRFAX PSYCHIATRY & BEHAVIORAL HEALTH CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRFAX PSYCHIATRY & BEHAVIORAL HEALTH CO.
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:
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:
1477897445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12486 ROSE PATH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-6238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-594-1755
Provider Business Mailing Address Fax Number:
703-218-8417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2915 HUNTER MILL RD
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
OAKTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22124-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-594-1755
Provider Business Practice Location Address Fax Number:
703-218-8417
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HINNARIA
Authorized Official First Name:
ANIL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
571-594-1755

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0101231724 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com