Provider Demographics
NPI:1376064147
Name:FAIRVIEW HOUSING MANAGEMENT CORP
Entity Type:Organization
Organization Name:FAIRVIEW HOUSING MANAGEMENT CORP
Other - Org Name:BRISTOL LIFESTYLE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-612-2995
Mailing Address - Street 1:PO BOX 5746
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5746
Mailing Address - Country:US
Mailing Address - Phone:423-612-2995
Mailing Address - Fax:
Practice Address - Street 1:261 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3275
Practice Address - Country:US
Practice Address - Phone:276-821-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLI0000000004235101YA0400X
251S00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health