Provider Demographics
NPI:1407559545
Name:A FAIR LIFE HOME
Entity Type:Organization
Organization Name:A FAIR LIFE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR-FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-304-2907
Mailing Address - Street 1:1700 NEEDMORE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3804
Mailing Address - Country:US
Mailing Address - Phone:937-300-3887
Mailing Address - Fax:
Practice Address - Street 1:1700 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3804
Practice Address - Country:US
Practice Address - Phone:937-300-3887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)