Provider Demographics
NPI:1104167212
Name:INOVA HEALTH CARE SERVICES
Entity type:Organization
Organization Name:INOVA HEALTH CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-289-8651
Mailing Address - Street 1:8110 GATEHOUSE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1252
Mailing Address - Country:US
Mailing Address - Phone:703-289-8651
Mailing Address - Fax:703-205-2367
Practice Address - Street 1:4027B OLLEY LANE
Practice Address - Street 2:BRADDOCK GLEN
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032
Practice Address - Country:US
Practice Address - Phone:703-239-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization