Provider Demographics
NPI:1336772086
Name:FAYETTEVILLE OPERATOR LLC
Entity Type:Organization
Organization Name:FAYETTEVILLE OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARRABINIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-815-5800
Mailing Address - Street 1:8000 WESTPARK DR STE 495
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3100
Mailing Address - Country:US
Mailing Address - Phone:703-815-5800
Mailing Address - Fax:
Practice Address - Street 1:115 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2689
Practice Address - Country:US
Practice Address - Phone:931-433-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility