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NPI Code Detail

MEDICARE: FAIRPORT ENTERPRISES, INC.

MEDICARE: FAIRPORT ENTERPRISES, INC.
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
1313M00000XNursing Facility/Intermediate Care Facility2082NOH
2314000000XSkilled Nursing Facility2082NOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497701445
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAIRPORT ENTERPRISES, INC.
Provider Business Mailing Address
First Line : 8181 WORTHINGTON RD
Second Line :
City : WESTERVILLE
State : OH
Zip : 43082-8067
Country : US
Telephone Number : 614-794-8800
Fax Number : 614-794-8826
Provider Business Practice Location Address
First Line : 2000 SHERMAN CIR NE
Second Line :
City : MASSILLON
State : OH
Zip : 44646-5219
Country : US
Telephone Number : 330-830-9988
Fax Number : 330-830-0039
Authorized Official
Title or Position : CFO
Name : MR. ANIS KHAN
Credential :
Telephone Number : 614-794-8800
Provider Enumeration Date : 05/25/2006
Last Update Date : 06/17/2016

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Directions to “FAIRPORT ENTERPRISES, INC. ” Practice Location

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