Provider Demographics
NPI:1588702526
Name:FAIRFAX HOSPITAL INC
Entity type:Organization
Organization Name:FAIRFAX HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ART THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DELLA PENTA
Authorized Official - Suffix:
Authorized Official - Credentials:ART-BC, LMHC
Authorized Official - Phone:425-821-2000
Mailing Address - Street 1:1729 12TH AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2492
Mailing Address - Country:US
Mailing Address - Phone:206-783-6850
Mailing Address - Fax:
Practice Address - Street 1:1711 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2435
Practice Address - Country:US
Practice Address - Phone:206-375-5872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05-019221700000X
WARC00053238273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
Not Answered273R00000XHospital UnitsPsychiatric Unit