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General NPI Number Information
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NPI Number | 1740934389
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Entity Type | Organization
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Legal Business Name | THE FAIRFAX HOUSE INC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 6955 FAIRFAX DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-5643
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Country | US
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Telephone | 727-843-9501
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Fax | 727-843-9501
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Provider Business Mailing Address
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Address Line | 6955 FAIRFAX DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-5643
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Country | US
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Telephone | 727-364-4116
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Fax | 727-843-9501
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DAVID VINCENT TAPP
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Credential |
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Telephone | 727-364-4116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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