NPIMap

Organization Active NPI

Fairfax County, Virginia

Doing business as Fairfax Falls Church Community Services Board - DD Services

  • Multi-Specialty Clinic/Center
  • Fairfax, VA
National Provider Identifier
1174558266
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
113 Issued in VA
Legal business name
FAIRFAX COUNTY, VIRGINIA
Doing business as
Fairfax Falls Church Community Services Board - DD Services
Practice address
12011 Government Center Pkwy
Suite 836
Fairfax, VA 22035-1100
Phone
(703) 324-7000
Fax
(703) 324-7092
NPI assigned
Jul 11, 2006
Last updated
Apr 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Authorized official

Name
Daryl Washington
Title
Executive Director
Phone
(703) 324-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 113 VA Primary

Addresses

Primary practice location

12011 Government Center Pkwy
Suite 836
Fairfax, VA 22035-1100

Mailing address

12000 Government Center Pkwy
Suite 552
Fairfax, VA 22035-0001
Phone (703) 324-3360

Other identifiers 1

IdentifierTypeStateIssuer
004945620MedicaidVA

Other names 1

  • Fairfax Falls Church Community Services Board - DD Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fairfax County Virginia6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1174558266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 GOVERNMENT CENTER PKWY",
            "address_2": "SUITE 552",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220350001",
            "telephone_number": "703-324-3360",
            "fax_number": "703-324-4573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12011 GOVERNMENT CENTER PKWY",
            "address_2": "SUITE 836",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220351100",
            "telephone_number": "703-324-7000",
            "fax_number": "703-324-7092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX COUNTY, VIRGINIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "DARYL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "703-324-7000"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "VA",
            "license": "113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945620",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfax Falls Church Community Services Board - DD Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.