- Enrollment id
- O20210310002270
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1033718382
- Multiple npi flag
- N
- Ccn
- 495099
- Associate id
- 4789090028
- Organization name
- FAIRFAX OPERATOR LLC
- Doing business as name
- FAIRFAX NURSING AND REHABILITATION CENTER
- Incorporation date
- 2020-08-17
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- FAIRFAX REHABILITATION AND NURSING CENTER
- Affiliation entity name
- LIFEWORKS REHAB
- Affiliation entity id
- 768
- Address line 1
- 10701 MAIN ST
- City
- FAIRFAX
- State
- VA
- Zip code
- 220306904