Provider Demographics
NPI:1457676736
Name:FAIRFIELD COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:FAIRFIELD COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANGELISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-277-6043
Mailing Address - Street 1:220 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4464
Mailing Address - Country:US
Mailing Address - Phone:740-277-6043
Mailing Address - Fax:
Practice Address - Street 1:220 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4464
Practice Address - Country:US
Practice Address - Phone:740-277-6043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3148105Medicaid
OH9391871Medicare PIN