MEDICARE: THE BAIR FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093927717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BAIR FOUNDATION

Provider Business Mailing Address
First Line	:	241 HIGH ST
Second Line	:
City	:	NEW WILMINGTON
State	:	PA
Zip	:	16142-1116
Country	:	US
Telephone Number	:	724-946-8711
Fax Number	:	724-946-3961

Provider Business Practice Location Address
First Line	:	715 E IDAHO AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-4703
Country	:	US
Telephone Number	:	505-647-1604
Fax Number	:	505-647-9063

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SUSAN J MIKLOS
Credential	:	MSSA
Telephone Number	:	724-946-8711

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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Directions to “THE BAIR FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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