Provider Demographics
NPI:1154356244
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 1:12011 GOVERNMENT CENTER PARKWAY
Mailing Address - Street 2:SUITE 836
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22035
Mailing Address - Country:US
Mailing Address - Phone:703-324-7000
Mailing Address - Fax:703-653-6626
Practice Address - Street 1:12011 GOVERNMENT CENTER PARKWAY
Practice Address - Street 2:SUITE 836
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22035
Practice Address - Country:US
Practice Address - Phone:703-324-7000
Practice Address - Fax:703-653-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
VA113261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA222044OtherANTHEM
VA010200229Medicaid
VAMHSSOtherAMERIGROUP
VA004945107Medicaid
VA010200270Medicaid
5700OtherCAREFIRST BCBS NCA
VA008743126Medicaid
VA010200181Medicaid
541705851OtherTRICARE
VA494601Medicare Oscar/Certification
=========OtherTRICARE
VA010200181Medicaid
VA410225Medicare PIN
VA004945107Medicaid