Provider Demographics
NPI:1467019778
Name:FAIRFIELD COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REGULATORY COMPLIANCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANTLEE
Authorized Official - Middle Name:SHAE
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-635-2154
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:408 W WASHINGTON STREET
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180
Mailing Address - Country:US
Mailing Address - Phone:803-635-2154
Mailing Address - Fax:803-635-1064
Practice Address - Street 1:408 W WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180
Practice Address - Country:US
Practice Address - Phone:803-635-2154
Practice Address - Fax:803-635-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency