Healthcare Provider Details

I. General information

NPI: 1912032012
Provider Name (Legal Business Name): INOVA HEALTH SYSTEM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 CHAIN BRIDGE RD
FAIRFAX VA
22030-3061
US

IV. Provider business mailing address

2990 TELESTAR CT SUITE 3LT
FALLS CHURCH VA
22042-1207
US

V. Phone/Fax

Practice location:
  • Phone: 703-934-5000
  • Fax: 703-934-5092
Mailing address:
  • Phone: 571-423-5747
  • Fax: 571-423-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2594
License Number StateVA

VIII. Authorized Official

Name: ROBERT HAGER
Title or Position: SENIOR ADMINSTRATOR
Credential:
Phone: 703-279-4252