NPI 1750612495

Medical Management of VA LLC

Organisation Substance Abuse Rehabilitation Facility Fairfax, VA

Practice location

Address: 10640 Main St Suite 300, Fairfax, VA 22030-3821
Phone: (954) 587-7771
Fax: (954) 208-5770
Mailing address: 11230 Waples Mill Rd Suite 125, Fairfax, VA 22030-6087

Authorised official

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

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 42902001 (VA)

Other Substance Abuse Rehabilitation Facility providers in Virginia →

Registry record

NPI: 1750612495
Entity type: Organization
NPI issued: 20 Jan 2010
Record last updated: 20 Jan 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.