Basic Information
| Provider Information | |||||||||
| NPI: | 1003159492 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MA-LOWE HOME CARE AGENCY FAIRFAX, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3022 JAVIER ROAD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033594430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3022 JAVIER ROAD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033594430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | LOWE | ||||||||
| AuthorizedOfficialFirstName: | MARIAMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7033594430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HCO-13689 | VA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0161625824 | 01 | MEDICAID PERSONAL CARE | OTHER | 0161626988 | 01 | MEDICAID RESPITE | OTHER |