OrganizationActive
Medical Management of Va LLC
NPI 1750612495 · Substance Abuse Rehabilitation Facility · Fairfax, VA
Provider details
- NPI number
- 1750612495
- Entity type
- Organization
- Primary specialty
- Substance Abuse Rehabilitation FacilityResidential Treatment Facilities
- Parent organization
- Bridging the Gaps
- Organization subpart
- Yes
- Authorized official
- Peter Ewens, Ceo(954) 587-7771
- License
- 42902001 (VA)
Specialties & taxonomies
Residential Treatment Facilities
Practice location
10640 Main St
Suite 300
Fairfax, VA 22030-3821
Phone: (954) 587-7771
Fax: (954) 208-5770
Approximate (ZIP-level) locationGet directions
Mailing address
11230 Waples Mill Rd
Fairfax, VA 22030-6087
Other names (DBA / former)
- Doing business as
- Horizons of Hope
Registry dates
- Enumerated
- 2010-01-20
- Last updated
- 2010-01-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.