Provider Demographics
NPI:1093136947
Name:ALEXANDRIA NEIGHBORHOOD HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ALEXANDRIA NEIGHBORHOOD HEALTH SERVICES, INC.
Other - Org Name:ANHSI-KING STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-535-5568
Mailing Address - Street 1:PO BOX 4320
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-4320
Mailing Address - Country:US
Mailing Address - Phone:703-535-5568
Mailing Address - Fax:
Practice Address - Street 1:4480 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1300
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164620027Medicaid
VAG01563Medicare PIN