Provider Demographics
NPI:1174558266
Name:FAIRFAX COUNTY, VIRGINIA
Entity type:Organization
Organization Name:FAIRFAX COUNTY, VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-324-7000
Mailing Address - Street 1:12000 GOVERNMENT CENTER PKWY
Mailing Address - Street 2:SUITE 552
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22035-0001
Mailing Address - Country:US
Mailing Address - Phone:703-324-3360
Mailing Address - Fax:703-324-4573
Practice Address - Street 1:12011 GOVERNMENT CENTER PKWY
Practice Address - Street 2:SUITE 836
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22035-1100
Practice Address - Country:US
Practice Address - Phone:703-324-7000
Practice Address - Fax:703-324-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA113261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945620Medicaid