Healthcare Provider Details

I. General information

NPI: 1346382066
Provider Name (Legal Business Name): FAIRFAX HEALTHCARE PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N MAIN ST
FAIRFAX OK
74637-3022
US

IV. Provider business mailing address

312 S MAIN ST
FAIRFAX OK
74637-3579
US

V. Phone/Fax

Practice location:
  • Phone: 918-642-5383
  • Fax: 918-642-3531
Mailing address:
  • Phone: 918-642-5383
  • Fax: 918-642-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number377233
License Number StateOK

VIII. Authorized Official

Name: MICHAEL J CHRISTIAN
Title or Position: CEO
Credential:
Phone: 918-642-8821