Provider Demographics
NPI:1336310549
Name:CRH CLINIC OF VIRGINIA, INC
Entity Type:Organization
Organization Name:CRH CLINIC OF VIRGINIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:425-284-7890
Mailing Address - Street 1:4040 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7874
Mailing Address - Country:US
Mailing Address - Phone:425-284-7890
Mailing Address - Fax:425-284-7896
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:UNIT 104
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-858-7345
Practice Address - Fax:703-894-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty