Provider Demographics
NPI:1497098008
Name:GOODWIN HOUSE BAILEY'S CROSSROADS
Entity Type:Organization
Organization Name:GOODWIN HOUSE BAILEY'S CROSSROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:703-578-7260
Mailing Address - Street 1:3440 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3440 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3145
Practice Address - Country:US
Practice Address - Phone:703-578-7260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODWIN HOUSE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF 447573-L155310400000X
VANH2559313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639258676Medicaid
VA495171Medicare PIN
VA495171Medicare Oscar/Certification