Provider Demographics
NPI:1023551546
Name:FAIRFIELD CENTER FOR DISABILITIES & CEREBRAL PALSY, INC.
Entity Type:Organization
Organization Name:FAIRFIELD CENTER FOR DISABILITIES & CEREBRAL PALSY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-653-5501
Mailing Address - Street 1:681 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2602
Mailing Address - Country:US
Mailing Address - Phone:740-653-5501
Mailing Address - Fax:740-653-6046
Practice Address - Street 1:681 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2602
Practice Address - Country:US
Practice Address - Phone:740-653-5501
Practice Address - Fax:740-653-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2301940OtherDEPARTMENT OF DEVELOPMENTAL DISABILITIES
OH2338751Medicaid
OH2128352Medicaid