Healthcare Provider Details

I. General information

NPI: 1740492743
Provider Name (Legal Business Name): FAYETTE RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 CONNELLSVILLE RD
LEMONT FURNACE PA
15456
US

IV. Provider business mailing address

1313 CONNELLSVILLE RD
LEMONT FURNACE PA
15456
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-6461
  • Fax: 724-437-6107
Mailing address:
  • Phone: 724-437-6461
  • Fax: 724-437-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number433950
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE FOX
Title or Position: CFO
Credential:
Phone: 724-437-6461