Provider Demographics
NPI:1750547444
Name:PRINCE WILLIAM AREA AGENCY ON AGING
Entity type:Organization
Organization Name:PRINCE WILLIAM AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-792-6439
Mailing Address - Street 1:5 COUNTY COMPLEX CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-9200
Mailing Address - Country:US
Mailing Address - Phone:703-792-6439
Mailing Address - Fax:703-792-4734
Practice Address - Street 1:5 COUNTY COMPLEX CT
Practice Address - Street 2:SUITE 240
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-9200
Practice Address - Country:US
Practice Address - Phone:703-792-6439
Practice Address - Fax:703-792-4734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCE WILLIAM COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-01
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0087303001261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087303001Medicaid