Fairfax Nursing Center, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2552 Issued in VA

Legal business name

FAIRFAX NURSING CENTER, INC

Practice address

10701 Main St
Fairfax, VA 22030-6904

Phone

(703) 273-7705

Fax

(703) 273-9066

NPI assigned

Aug 18, 2005

Last updated

Aug 7, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Renee Bainum Carlson

Title

Executive Administrator

Phone

(703) 273-7705

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438905600000",
    "number": "1386636116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10701 MAIN ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306904",
            "telephone_number": "703-273-7705",
            "fax_number": "703-273-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10701 MAIN ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306904",
            "telephone_number": "703-273-7705",
            "fax_number": "703-273-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX NURSING CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2015-08-07",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "BAINUM",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR",
        "authorized_official_telephone_number": "703-273-7705",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS PROVIDER NO.",
            "identifier": "442051",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MC B DME PROVIDER NUMBER",
            "identifier": "0573480001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004950992",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fairfax Neonatal Associates, P.C. (Pediatric Infectious Disease Group)
• Fairfax Neonatal Associates, P.C. (Pediatric Infectious Disease Group)
• Fairfax Neonatal Associates, PC (Pediatric Lung and Allergy Center)
• Fairfax Neonatal Associates, PC (Pediatric Surgical Group)
• Fairfax Nursing Center Pharmacy
• Fairfax OB-GYN Associates, Inc.
• Fairfax Operator LLC (Fairfax Rehabilitation and Nursing Center)
• Fairfax Optometry, LLC (My Eye Dr.)
• Fairfax Oral and Maxillofacial Surgery PC
• Fairfax Oriental Acupuncture

• Skilled Nursing Facility in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; 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.