| Clementine Fairfax | |
|
11329 Henderson Rd Fairfax Station VA 22039-2314 | |
| (305) 663-1876 | |
| Not Available |
| Full Name | Clementine Fairfax |
|---|---|
| Speciality | Psychiatric Residential Treatment Facility |
| Location | 11329 Henderson Rd, Fairfax Station, Virginia |
| Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3056631876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clementine Fairfax 6100 Sw 76th St South Miami FL 33143-5002 Ph: (305) 663-1876 | Clementine Fairfax 11329 Henderson Rd Fairfax Station VA 22039-2314 Ph: (305) 663-1876 |
| NPI Number | 1689269250 |
|---|---|
| Provider Enumeration Date | 03/05/2021 |
| Last Update Date | 10/17/2024 |
| Certification Date | 10/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689269250 | NPI | - | NPPES |
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