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
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
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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