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24440 Stone Springs Blvd Dulles VA 20166-2247 | |
| (571) 349-4000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 24440 Stone Springs Blvd, Dulles, Virginia |
| Authorized Official Name and Position | Christopher J. Landry (CFO) |
| Authorized Official Contact | 8042894587 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
24440 Stone Springs Blvd Dulles VA 20166-2247 Ph: (571) 349-4000 | 24440 Stone Springs Blvd Dulles VA 20166-2247 Ph: (571) 349-4000 |
| NPI Number | 1881367217 |
|---|---|
| Provider Enumeration Date | 07/30/2021 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/21/2023 |
| Medicare PECOS PAC ID | 2567351760 |
|---|---|
| Medicare Enrollment ID | O20211202001865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881367217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |