Healthcare Provider Details

I. General information

NPI: 1740934389
Provider Name (Legal Business Name): THE FAIRFAX HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FAIRFAX DR
PORT RICHEY FL
34668-5643
US

IV. Provider business mailing address

6955 FAIRFAX DR
PORT RICHEY FL
34668-5643
US

V. Phone/Fax

Practice location:
  • Phone: 727-843-9501
  • Fax: 727-843-9501
Mailing address:
  • Phone: 727-364-4116
  • Fax: 727-843-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID VINCENT TAPP
Title or Position: DIRECTOR
Credential:
Phone: 727-364-4116