Healthcare Provider Details

I. General information

NPI: 1093050304
Provider Name (Legal Business Name): MSH/HUNTER MILL OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 HUNTER MILL RD
OAKTON VA
22124-1702
US

IV. Provider business mailing address

2863 HUNTER MILL RD
HUNTER MILL VA
22124-1702
US

V. Phone/Fax

Practice location:
  • Phone: 703-255-1006
  • Fax: 703-255-1007
Mailing address:
  • Phone: 703-255-1006
  • Fax: 703-255-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF 1082985-L151
License Number StateVA

VIII. Authorized Official

Name: LAURIE HENSLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-255-1006