Basic Information
| Provider Information | |||||||||
| NPI: | 1841744265 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEIGHBORHOOD HEALTH | ||||||||
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| OtherOrganizationName: | NEIGHBORHOOD HEALTH ANNANDALE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4320 | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230584320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042377690 | ||||||||
| FaxNumber: | 8042377697 | ||||||||
| Practice Location | |||||||||
| Address1: | 7501 LITTLE RIVER TPKE | ||||||||
| Address2: | G-4 | ||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220032923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355568 | ||||||||
| FaxNumber: | 7032243629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2016 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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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 CEO | ||||||||
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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.