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General NPI Number Information
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NPI Number | 1912032012
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Entity Type | Organization
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Legal Business Name | INOVA HEALTH SYSTEM SERVICES
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 4315 CHAIN BRIDGE RD
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City | FAIRFAX
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State | VA
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Zip | 22030-3061
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Country | US
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Telephone | 703-934-5000
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Fax | 703-934-5092
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Provider Business Mailing Address
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Address Line | 2990 TELESTAR CT SUITE 3LT
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1207
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Country | US
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Telephone | 571-423-5747
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Fax | 571-423-5703
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Authorized Official
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Title or Position | SENIOR ADMINSTRATOR
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Name | ROBERT HAGER
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Credential |
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Telephone | 703-279-4252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH2594
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License Number State | VA
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