Provider Demographics
NPI:1689346926
Name:LOUDEN FAIRFAX CARE LLC
Entity Type:Organization
Organization Name:LOUDEN FAIRFAX CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:COLBY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:REP
Authorized Official - Phone:912-741-8980
Mailing Address - Street 1:207 INSTITUTE ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0920
Mailing Address - Country:US
Mailing Address - Phone:912-741-8980
Mailing Address - Fax:
Practice Address - Street 1:207 INSTITUTE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0920
Practice Address - Country:US
Practice Address - Phone:912-741-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care