OrganizationActive
Clementine Twin Lakes, LLC
NPI 1689269250 · Psychiatric Residential Treatment Facility · Fairfax Station, VA
Provider details
- NPI number
- 1689269250
- Entity type
- Organization
- Primary specialty
- Psychiatric Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Mike Bagley, Chief Financial Officer(305) 663-1876
Specialties & taxonomies
Residential Treatment Facilities
Residential Treatment Facilities
Ambulatory Health Care Facilities
Profile Score
Established profile(62/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
11329 Henderson Rd
Fairfax Station, VA 22039-2314
Phone: (305) 663-1876
Street-level locationGet directions
Mailing address
6100 Sw 76th St
South Miami, FL 33143-5002
Other names (DBA / former)
- Doing business as
- Clementine Fairfax
- Doing business as
- Clementine Fairfax
Registry dates
- Enumerated
- 2021-03-05
- Last updated
- 2025-10-16
- Certified
- 2025-10-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.