Provider Demographics
NPI:1164588992
Name:SOCIETY FOR HANDICAPPED CITIZENS INC.
Entity Type:Organization
Organization Name:SOCIETY FOR HANDICAPPED CITIZENS INC.
Other - Org Name:FAIRVIEW HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SEEBACH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:937-746-4201
Mailing Address - Street 1:624 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-3145
Mailing Address - Country:US
Mailing Address - Phone:937-746-4201
Mailing Address - Fax:937-746-8437
Practice Address - Street 1:624 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-3145
Practice Address - Country:US
Practice Address - Phone:937-746-4201
Practice Address - Fax:937-746-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8310107320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0596467Medicaid