Provider Demographics
NPI:1629109806
Name:LOUDOUN COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:LOUDOUN COMMUNITY HEALTH CENTER
Other - Org Name:HEALTHWORKS FOR NORTHERN VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:703-840-4704
Mailing Address - Street 1:163 FORT EVANS ROAD, NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4420
Mailing Address - Country:US
Mailing Address - Phone:703-840-4707
Mailing Address - Fax:703-771-4120
Practice Address - Street 1:163 FORT EVANS ROAD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4420
Practice Address - Country:US
Practice Address - Phone:703-443-2000
Practice Address - Fax:703-443-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-10-20
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
VA1629109806Medicaid
VA491887Medicare Oscar/Certification
VAC10139Medicare PIN