Provider Demographics
NPI:1548361025
Name:CHILD HEALTH CARE OF MANASSAS, INC.
Entity type:Organization
Organization Name:CHILD HEALTH CARE OF MANASSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:KRENYTZLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-369-3316
Mailing Address - Street 1:9394 FORESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4702
Mailing Address - Country:US
Mailing Address - Phone:703-369-3316
Mailing Address - Fax:703-257-7600
Practice Address - Street 1:9394 FORESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4702
Practice Address - Country:US
Practice Address - Phone:703-369-3316
Practice Address - Fax:703-257-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid