Healthcare Provider Details

I. General information

NPI: 1396024212
Provider Name (Legal Business Name): FAIRFIELD COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 07/17/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W MARKET ST SUITE H
BALTIMORE OH
43105-1283
US

IV. Provider business mailing address

220 E WALNUT ST
LANCASTER OH
43130-4464
US

V. Phone/Fax

Practice location:
  • Phone: 740-277-6043
  • Fax:
Mailing address:
  • Phone: 740-277-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LISA EVANGELISTA
Title or Position: CEO
Credential:
Phone: 740-277-6043