CLEMENTINE TWIN LAKES, LLC
NPI 1689269250
Psychiatric Residential Treatment Facility in Fairfax Station, VA

Active since March 05, 2021
11329 HENDERSON RD, FAIRFAX STATION, VA 22039(305) 663-1876 Get Directions Write a Review

NPPES record last updated: October 16, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Clementine Twin Lakes, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEMENTINE TWIN LAKES, LLC (NPI 1689269250), doing business as Clementine Fairfax, is a healthcare organization registered as a psychiatric residential treatment facility in Fairfax Station, Virginia and active in the NPI registry since March 2021. The organization lists Mike Bagley, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1689269250
Entity TypeOrganization
Primary Taxonomy323P00000X
Legal Business NameCLEMENTINE TWIN LAKES, LLC
Location Address11329 HENDERSON RDFairfax Station, VA 22039-2314
Mailing Address6100 Sw 76th StSouth Miami, FL 33143-5002 · (305) 663-1876
Organization SubpartNo
Authorized OfficialMike BagleyChief Financial Officer · (305) 663-1876
Enumeration DateMarch 5, 2021
Last NPPES UpdateOctober 16, 2025
NPPES CertifiedOctober 16, 2025
NPI 1689269250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPsychiatric Residential Treatment FacilityResidential Treatment Facilities
Taxonomy Code323P00000X
Definition
A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary
11329 HENDERSON RD, Fairfax Station, VA 22039

Other Names 1

Doing Business AsClementine Fairfax

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clementine Twin Lakes, LLC's NPI number?

The NPI number for Clementine Twin Lakes, LLC is 1689269250. It was assigned to this organization in the NPPES registry on March 5, 2021. The provider is doing business as Clementine Fairfax.

Where is Clementine Twin Lakes, LLC located?

Clementine Twin Lakes, LLC is located at 11329 Henderson Rd, Fairfax Station, VA 22039. The listed phone number is (305) 663-1876.

What is Clementine Twin Lakes, LLC's specialty?

The primary specialty registered for this NPI is Psychiatric Residential Treatment Facility with taxonomy code 323P00000X.

When was this NPI record last updated?

The NPPES record for Clementine Twin Lakes, LLC was last updated on October 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.