# FAIRFAX NURSING CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386636116
- **Authorized official:** MS. RENEE BAINUM CARLSON (EXECUTIVE ADMINISTRATOR)
- **Authorized official phone:** (703) 273-7705

## Contact information

- **Practice address:** 10701 MAIN ST, FAIRFAX, VA 22030-6904
- **Practice address phone:** (703) 273-7705
- **Practice address fax:** (703) 273-9066
- **Mailing address:** 10701 MAIN ST, FAIRFAX, VA 22030-6904
- **Mailing address phone:** (703) 273-7705
- **Mailing address fax:** (703) 273-8077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2552 | VA | Yes |

## Other

- **Enumeration date:** 08/18/2005
- **Last updated:** 08/07/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004950992 | — | VA |
| 01 | — | 0573480001 | MC B DME PROVIDER NUMBER | VA |
| 01 | — | 442051 | ANTHEM BC/BS PROVIDER NO. | VA |