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General NPI Number Information
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NPI Number | 1174519102
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Entity Type | Organization
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Legal Business Name | FAIRVIEW HOME HEALTH LLC
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 1025 W CHERRY AVE
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City | ENID
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State | OK
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Zip | 73703-3318
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Country | US
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Telephone | 580-237-1819
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Fax | 580-237-1822
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Provider Business Mailing Address
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Address Line | 1025 W CHERRY AVE
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City | ENID
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State | OK
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Zip | 73703-3318
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Country | US
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Telephone | 580-237-1819
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Fax | 580-237-1822
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LOLA JANE EDWARDS
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Credential | RN
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Telephone | 802-371-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7153
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License Number State | OK
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