Provider Demographics
NPI:1154674026
Name:NEIGHBORHOOD HEALTH
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH
Other - Org Name:ENGLESIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:703-535-1583
Practice Address - Street 1:8637 ENGLESIDE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4132
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:703-535-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164620027Medicaid
VA491931Medicare Oscar/Certification