NPIMap

Organization Active NPI

Fairfax Falls Church Community Service Board

  • Substance Abuse Rehabilitation Facility
  • Chantilly, VA
National Provider Identifier
1104161736
Registry record updated Dec 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
0002052809 Issued in VA
Legal business name
FAIRFAX FALLS CHURCH COMMUNITY SERVICE BOARD
Practice address
4213 Walney Rd
Chantilly, VA 20151-2923
Phone
(703) 502-7000
NPI assigned
Dec 8, 2012
Last updated
Dec 8, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
FAIRFAX COUNTY GOVT.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rosaline NankamNPI 1942353198
Title
RN/ Supervisor
Phone
(703) 502-7005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 0002052809 VA Primary

Addresses

Primary practice location

4213 Walney Rd
Chantilly, VA 20151-2923

Mailing address

4213 Walney Rd
Chantilly, VA 20151-2923
Phone (703) 502-5005

National Provider Directory

National Provider Directory
Part of
Community Programs Inc

Locations

4213 Walney Rd
Chantilly, VA 20151
Phone (703) 502-7000

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354924800000",
    "number": "1104161736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 WALNEY RD",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512923",
            "telephone_number": "703-502-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4213 WALNEY RD",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512923",
            "telephone_number": "703-502-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX FALLS CHURCH COMMUNITY SERVICE BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIRFAX COUNTY GOVT.",
        "enumeration_date": "2012-12-08",
        "last_updated": "2012-12-08",
        "status": "A",
        "authorized_official_last_name": "NANKAM",
        "authorized_official_first_name": "ROSALINE",
        "authorized_official_title_or_position": "RN/ SUPERVISOR",
        "authorized_official_telephone_number": "703-502-7005"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "VA",
            "license": "0002052809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.