Provider Demographics
NPI:1619365962
Name:WC- FAIRFIELD OPS, LLC
Entity Type:Organization
Organization Name:WC- FAIRFIELD OPS, LLC
Other - Org Name:BROOKSTONE ESTATES OF FAIRFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-842-5875
Mailing Address - Street 1:315 MARKET AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2611
Mailing Address - Country:US
Mailing Address - Phone:618-842-5875
Mailing Address - Fax:618-842-5870
Practice Address - Street 1:315 MARKET AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2611
Practice Address - Country:US
Practice Address - Phone:618-842-5875
Practice Address - Fax:618-842-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility