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FAIRFIELD COMMUNITY SUPPORTS NPI 1073128534


NPI Information

NPI: 1073128534
Provider Name: FAIRFIELD COMMUNITY SUPPORTS
Classification: Day Training, Developmentally Disabled Services - 251C00000X
Entity Type: Organization

CLIA Number: 36D1006347

Address:
15663 STATE ROUTE 595
LOGAN, OH
ZIP 43138
Phone: (740) 216-4807
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FAIRFIELD COMMUNITY SUPPORTS is a day training developmentally disabled services in Logan, OH. The provider is these agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. FAIRFIELD COMMUNITY SUPPORTS NPI is 1073128534. The provider is registered as an organization entity type.

The provider's business location address is:

15663 STATE ROUTE 595
LOGAN, OH
ZIP 43138-850
Phone: (740) 216-4807

The provider's authorized official is Jessica Hoag .
The authorized official title is Ceo and has the following contact phone number (740) 216-4807.

The CLIA number assigned to this NPI record is 36D1006347 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/11/2020 and was last updated on 9/11/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251C00000XDay Training, Developmentally Disabled ServicesYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10303222MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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