Basic Information
| Provider Information | |||||||||
| NPI: | 1396489753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUDOUN COMMUNITY HEALTH CENTER | ||||||||
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| OtherOrganizationName: | HEALTH WORKS FOR NORTHERN VIRGINIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 FORT EVANS RD NE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034757595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16300 WALL ROAD | ||||||||
| Address2: | SUITE 055 | ||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034432000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2022 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | DHINDSA | ||||||||
| AuthorizedOfficialFirstName: | AMANDEEP | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7034757595 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LOUDOUN COMMUNITY HEALTH CENTER | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
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.