Provider Demographics
NPI:1568641173
Name:FAIRVIEW ELEMENTARY
Entity Type:Organization
Organization Name:FAIRVIEW ELEMENTARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR II
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:606-329-9444
Mailing Address - Street 1:PO BOX 4069
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-4069
Mailing Address - Country:US
Mailing Address - Phone:606-329-9444
Mailing Address - Fax:606-324-5423
Practice Address - Street 1:258 MCKNIGHT ST # WW
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-4339
Practice Address - Country:US
Practice Address - Phone:606-325-1528
Practice Address - Fax:606-324-5423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLAND-BOYD COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1107179251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20000840Medicaid
KY1164526489OtherNPI
KY1023011509OtherNPI
KYG62131Medicare UPIN
KYX97925Medicare UPIN
KY07888Medicare PIN