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Organization
LONE JACK HOLDINGS, INC.
Active
Organization
LONE JACK HOLDINGS, INC.
Active
Other names
BrightStar of Fairfax
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT WITHERS MASSIE IV (PRESIDENT)
(630) 699-5900
Entity
Organization
Contact information
Practice address
10517 BRADDOCK RD STE C, FAIRFAX, VA 22032-2275
(703) 267-2380
(703) 267-2384
Mailing address
10517 BRADDOCK RD STE C, FAIRFAX, VA 22032-2275
(703) 267-2380
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
251J00000X
Nursing Care Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NONE
VA
Enumeration date
07/30/2012
Last updated
11/25/2024
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