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General NPI Number Information
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NPI Number | 1407004278
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Entity Type | Organization
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Legal Business Name | ARDEN COURTS-FAIR OAKS OF FAIRFAX VA LLC
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 12469 LEE JACKSON MEMORIAL HWY
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City | FAIRFAX
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State | VA
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Zip | 22033-2803
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Country | US
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Telephone | 703-383-0060
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Fax | 703-383-1237
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST ATTN BARRY A LAZARUS
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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Country | US
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Telephone | 419-252-5541
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Fax | 419-254-5494
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Authorized Official
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Title or Position | VICE PRESIDENT - REIMBURSEMENT
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Name | MR. BARRY A LAZARUS
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Credential |
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Telephone | 419-252-5541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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