Basic Information
| Provider Information | |||||||||
| NPI: | 1093486680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEIGHBORHOOD HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6677 RICHMOND HWY | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223066647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355568 | ||||||||
| FaxNumber: | 7032991794 | ||||||||
| Practice Location | |||||||||
| Address1: | 6715 LITTLE RIVER TPKE STE 201 | ||||||||
| Address2: | |||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220033546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | BASIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7035355568 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.