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General NPI Number Information
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NPI Number | 1043887847
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Entity Type | Organization
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Legal Business Name | FAIRIELD BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 5979 E LIVINGSTON AVE STE 201
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City | COLUMBUS
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State | OH
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Zip | 43232-2908
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Country | US
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Telephone | 614-377-3391
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Fax | 614-662-1006
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Provider Business Mailing Address
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Address Line | 5979 E LIVINGSTON AVE STE 201
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City | COLUMBUS
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State | OH
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Zip | 43232-2908
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Country | US
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Telephone | 614-377-3391
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Fax | 614-662-1006
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | PAMELA TEGEMAH NKWENTI
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Credential | APRN
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Telephone | 614-377-3391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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