MEDICARE: FAIRFAX PLACE AT HOME

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1376882266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFAX PLACE AT HOME

Provider Business Mailing Address
First Line	:	9014 CEDAR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2932
Country	:	US
Telephone Number	:	216-795-1363
Fax Number	:	216-795-8060

Provider Business Practice Location Address
First Line	:	9014 CEDAR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2932
Country	:	US
Telephone Number	:	216-795-1363
Fax Number	:	216-795-8060

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. HENRY HERMAN EDWARDS JR.
Credential	:
Telephone Number	:	216-795-1363

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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Directions to “FAIRFAX PLACE AT HOME ” Practice Location

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