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General NPI Number Information
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NPI Number | 1346382066
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Entity Type | Organization
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Legal Business Name | FAIRFAX HEALTHCARE PROPERTIES, LLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 153 N MAIN ST
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City | FAIRFAX
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State | OK
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Zip | 74637-3022
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Country | US
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Telephone | 918-642-5383
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Fax | 918-642-3531
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Provider Business Mailing Address
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Address Line | 312 S MAIN ST
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City | FAIRFAX
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State | OK
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Zip | 74637-3579
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Country | US
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Telephone | 918-642-5383
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Fax | 918-642-3531
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL J CHRISTIAN
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Credential |
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Telephone | 918-642-8821
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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 | 377233
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License Number State | OK
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