NPIMap

Organization Active NPI

Medical Management of VA LLC

Doing business as Horizons of Hope

  • Substance Abuse Rehabilitation Facility
  • Fairfax, VA
National Provider Identifier
1750612495
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
42902001 Issued in VA
Legal business name
MEDICAL MANAGEMENT OF VA LLC
Doing business as
Horizons of Hope
Practice address
10640 Main St
Suite 300
Fairfax, VA 22030-3821
Phone
(954) 587-7771
Fax
(954) 208-5770
NPI assigned
Jan 20, 2010
Last updated
Jan 20, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
BRIDGING THE GAPSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

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

Authorized official

Name
Mr. Peter Ewens
Title
Ceo
Phone
(954) 587-7771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 42902001 VA Primary

Addresses

Primary practice location

10640 Main St
Suite 300
Fairfax, VA 22030-3821

Mailing address

11230 Waples Mill Rd
Suite 125
Fairfax, VA 22030-6087
Phone (954) 587-7771

Other names 1

  • HORIZONS OF HOPE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Horizons of Hope3 organizations share this tax ID, including this one
Part of
Bridging the Gaps

Other organizations with this tax ID 2

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

Locations

10640 Main St
Ste 300
Fairfax, VA 22030
Phone (703) 246-9355

NPI Registry JSON

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1750612495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 WAPLES MILL RD",
            "address_2": "SUITE 125",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306087",
            "telephone_number": "954-587-7771",
            "fax_number": "954-208-5770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10640 MAIN ST",
            "address_2": "SUITE 300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303821",
            "telephone_number": "954-587-7771",
            "fax_number": "954-208-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MANAGEMENT OF VA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIDGING THE GAPS",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "EWENS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-587-7771",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "VA",
            "license": "42902001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HORIZONS OF HOPE",
            "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 Jan 20, 2010; 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.