Provider Demographics
| NPI: | 1386753291 |
|---|---|
| Name: | COUNTY OF LOUDOUN, VIRGINIA |
| Entity type: | Organization |
| Organization Name: | COUNTY OF LOUDOUN, VIRGINIA |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | AGENCY DIRECTOR |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | MARGARET |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GRAHAM |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 703-771-5406 |
| Mailing Address - Street 1: | 906 TRAILVIEW BLVD SE |
| Mailing Address - Street 2: | SUITE C |
| Mailing Address - City: | LEESBURG |
| Mailing Address - State: | VA |
| Mailing Address - Zip Code: | 20175-4415 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 703-737-8677 |
| Mailing Address - Fax: | 703-737-8676 |
| Practice Address - Street 1: | 102 HERITAGE WAY NE |
| Practice Address - Street 2: | SUITE 310 |
| Practice Address - City: | LEESBURG |
| Practice Address - State: | VA |
| Practice Address - Zip Code: | 20176-4544 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 703-737-8677 |
| Practice Address - Fax: | 703-737-8676 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | COUNTY OF LOUDOUN, VIRGINIA |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-08-30 |
| Last Update Date: | 2017-01-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| VA | 143 | 251B00000X, 261QD1600X, 261QR0400X, 310500000X, 320600000X, 320800000X, 385HR2060X, 251C00000X, 251S00000X, 252Y00000X, 261QM0801X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 251B00000X | Agencies | Case Management | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
| No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| VA | 004945140 | Medicaid | |
| VA | 187217 | Other | ANTHEM SLP |
| VA | LCCB | Other | AMERIGROUP - VIRGINIA |
| VA | 004980433 | Medicaid | |
| VA | 187219 | Other | ANTHEM OT |
| VA | 187220 | Other | ANTHEM PT |
| VA | 008743673 | Medicaid | |
| VA | C03212 | Medicare PIN | |
| VA | C03213 | Medicare PIN |
