Provider Demographics
NPI:1487665055
Name:FAIRFIELD BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:FAIRFIELD BEHAVIORAL HEALTH SERVICES
Other - Org Name:FAIRFIELD COUNTY SUBSTANCE ABUSE COMMISSION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA CPP
Authorized Official - Phone:803-635-2335
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180
Mailing Address - Country:US
Mailing Address - Phone:803-635-2335
Mailing Address - Fax:803-635-9695
Practice Address - Street 1:178 US HIGHWAY 321 BYPASS N.
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180
Practice Address - Country:US
Practice Address - Phone:803-635-2335
Practice Address - Fax:803-635-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD25FAMedicaid