Organization
FAIRFAX NURSING CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENEE BAINUM CARLSON (EXECUTIVE ADMINISTRATOR)
(703) 273-7705
Entity
Organization
Contact information
Practice address
10701 MAIN ST, FAIRFAX, VA 22030-6904
(703) 273-7705
(703) 273-9066
Mailing address
10701 MAIN ST, FAIRFAX, VA 22030-6904
(703) 273-7705
(703) 273-8077
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2552
VA
Other
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
Enumeration date
08/18/2005
Last updated
08/07/2015
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