Provider Demographics
NPI:1124471180
Name:FAIRFAX HOME BIRTH
Entity type:Organization
Organization Name:FAIRFAX HOME BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MIDWIFE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STORY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:703-534-0373
Mailing Address - Street 1:10805 NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2932
Mailing Address - Country:US
Mailing Address - Phone:703-534-0373
Mailing Address - Fax:703-543-9397
Practice Address - Street 1:10805 NORMAN AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2932
Practice Address - Country:US
Practice Address - Phone:703-534-0373
Practice Address - Fax:703-543-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing