Healthcare Provider Details

I. General information

NPI: 1477559342
Provider Name (Legal Business Name): AIR FORCE RETIRED OFFICERS COMMUNITY-WASHINGTON D.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20535 EARHART PL
STERLING VA
20165-3581
US

IV. Provider business mailing address

20535 EARHART PL
POTOMAC FALLS VA
20165-3581
US

V. Phone/Fax

Practice location:
  • Phone: 703-404-5208
  • Fax:
Mailing address:
  • Phone: 703-404-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2600
License Number StateVA

VIII. Authorized Official

Name: FRED RICHARD BOVA JR.
Title or Position: CFO
Credential:
Phone: 703-404-5145