Provider Demographics
NPI:1386753291
Name:COUNTY OF LOUDOUN, VIRGINIA
Entity type:Organization
Organization Name:COUNTY OF LOUDOUN, VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-771-5406
Mailing Address - Street 1:906 TRAILVIEW BLVD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4415
Mailing Address - Country:US
Mailing Address - Phone:703-737-8677
Mailing Address - Fax:703-737-8676
Practice Address - Street 1:102 HERITAGE WAY NE
Practice Address - Street 2:SUITE 310
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-737-8677
Practice Address - Fax:703-737-8676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LOUDOUN, VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA143251B00000X, 251C00000X, 251S00000X, 252Y00000X, 261QD1600X, 261QM0801X, 261QR0400X, 310500000X, 320600000X, 320800000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945140Medicaid
VA187217OtherANTHEM SLP
VALCCBOtherAMERIGROUP - VIRGINIA
VA004980433Medicaid
VA187219OtherANTHEM OT
VA187220OtherANTHEM PT
VA008743673Medicaid
VAC03212Medicare PIN
VAC03213Medicare PIN