Provider Demographics
NPI:1275842387
Name:LOUDOUN COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:LOUDOUN COMMUNITY HEALTH CENTER
Other - Org Name:THE HEALTH CENTER FOR CHILDREN AND FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-443-2000
Mailing Address - Street 1:PO BOX 6944
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0944
Mailing Address - Country:US
Mailing Address - Phone:804-237-7690
Mailing Address - Fax:804-237-7697
Practice Address - Street 1:46440 BENEDICT DR
Practice Address - Street 2:SUITE 208
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:571-434-0022
Practice Address - Fax:571-434-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10139Medicare PIN
491905Medicare Oscar/Certification