Healthcare Provider Details

I. General information

NPI: 1801630801
Provider Name (Legal Business Name): CATHOLIC CHARATIES DIOCESE OF ARLINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 FORESTWOOD LN STE B
MANASSAS VA
20110-4735
US

IV. Provider business mailing address

9380 FORESTWOOD LN STE B
MANASSAS VA
20110-4735
US

V. Phone/Fax

Practice location:
  • Phone: 703-335-2779
  • Fax: 703-420-8993
Mailing address:
  • Phone: 703-335-2779
  • Fax: 703-420-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXANDRA LUEVANO
Title or Position: PROGRAM DIRECTOR
Credential: RN
Phone: 703-420-8992