Healthcare Provider Details

I. General information

NPI: 1790619534
Provider Name (Legal Business Name): FAIR CHILD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 MAIN ST
SAINT JOSEPH MI
49085-1235
US

IV. Provider business mailing address

414 MAIN ST
SAINT JOSEPH MI
49085-1235
US

V. Phone/Fax

Practice location:
  • Phone: 269-262-1591
  • Fax:
Mailing address:
  • Phone: 269-262-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH J FAIRCHILD
Title or Position: LICENSED CLINICAL MASTER SOCIAL WOR
Credential: LMSW- C
Phone: 269-262-1591