Provider Demographics
NPI:1043920754
Name:FAIRWAY CHALET, INC.
Entity Type:Organization
Organization Name:FAIRWAY CHALET, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEBT
Authorized Official - Prefix:
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:
Authorized Official - Last Name:LABIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-934-4970
Mailing Address - Street 1:905 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2677
Practice Address - Country:US
Practice Address - Phone:727-934-4970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services