| Organization Name: | FAIRFAX FALLS CHURCH COMMUNITY SERVICE BOARD |
| NPI Number: | 1104161736 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROSALINE NANKAM (RN/ SUPERVISOR) |
| Mailing Address: | 4213 Walney Rd Chantilly |
| State: | VA US |
| Postal Code: | 201512923 |
| Phone Number: | 7035027000 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2012 |
| NPI Last Update Date: | 12/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | 0002052809 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |