Provider Demographics
NPI:1811003551
Name:FAYCO ENTERPRISES INC
Entity Type:Organization
Organization Name:FAYCO ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-0638
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:1313 SUNSET DRIVE
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471
Mailing Address - Country:US
Mailing Address - Phone:618-283-0638
Mailing Address - Fax:618-283-3892
Practice Address - Street 1:1313 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471
Practice Address - Country:US
Practice Address - Phone:618-283-0638
Practice Address - Fax:618-283-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)