Provider Demographics
NPI:1174086938
Name:LOUDOUN COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:LOUDOUN COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-443-2000
Mailing Address - Street 1:163 FORT EVANS RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4420
Mailing Address - Country:US
Mailing Address - Phone:703-840-4707
Mailing Address - Fax:
Practice Address - Street 1:11484 WASHINGTON PLZ W STE 300
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4342
Practice Address - Country:US
Practice Address - Phone:703-443-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUDOUN COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)