Healthcare Provider Details

I. General information

NPI: 1437487758
Provider Name (Legal Business Name): FAIRFAX COMMUNITY HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 10TH AVE SE
FAIRFAX MN
55332-2149
US

IV. Provider business mailing address

300 10TH AVE SE
FAIRFAX MN
55332-2149
US

V. Phone/Fax

Practice location:
  • Phone: 507-426-8241
  • Fax: 507-426-7340
Mailing address:
  • Phone: 507-426-8241
  • Fax: 507-426-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number345866
License Number StateMN

VIII. Authorized Official

Name: JUDITH A SANDMANN
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-426-8241