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General NPI Number Information
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NPI Number | 1407240237
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Entity Type | Organization
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Legal Business Name | FAIRCHILD HOME AND COMMUNITY BASED SERVICES, LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 205 E MAPLE
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City | BILLINGS
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State | OK
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Zip | 74630
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Country | US
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Telephone | 580-725-3400
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Fax | 580-725-3402
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Provider Business Mailing Address
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Address Line | PO BOX 366 205 E MAPLE
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City | BILLINGS
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State | OK
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Zip | 74630
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Country | US
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Telephone | 580-725-3400
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Fax | 580-725-3402
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CONSUELA F LOGAN
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Credential | QIDP
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Telephone | 580-725-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | NH5204-5204
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License Number State | OK
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