# LONE JACK HOLDINGS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BrightStar of Fairfax
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124374061
- **Authorized official:** MR. ROBERT WITHERS MASSIE IV (PRESIDENT)
- **Authorized official phone:** (630) 699-5900

## Contact information

- **Practice address:** 10517 BRADDOCK RD STE C, FAIRFAX, VA 22032-2275
- **Practice address phone:** (703) 267-2380
- **Practice address fax:** (703) 267-2384
- **Mailing address:** 10517 BRADDOCK RD STE C, FAIRFAX, VA 22032-2275
- **Mailing address phone:** (703) 267-2380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 07/30/2012
- **Last updated:** 11/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0 | NONE | VA |