Provider Demographics
NPI:1528407954
Name:FAIRFIELD HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:FAIRFIELD HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FONGOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-314-5416
Mailing Address - Street 1:3830 WOODRIDGE BLVD UNIT G
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-942-0304
Mailing Address - Fax:
Practice Address - Street 1:3174 MACK RD STE 6
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5369
Practice Address - Country:US
Practice Address - Phone:513-942-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2205869251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health