Provider Demographics
NPI:1063767523
Name:FAIRFAX HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:FAIRFAX HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-546-8555
Mailing Address - Street 1:171 ELDEN ST STE 3A1
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4976
Mailing Address - Country:US
Mailing Address - Phone:571-315-7333
Mailing Address - Fax:855-255-0578
Practice Address - Street 1:171 ELDEN ST STE 3A1
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4976
Practice Address - Country:US
Practice Address - Phone:571-315-7333
Practice Address - Fax:855-255-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health