Provider Demographics
NPI:1861464653
Name:THE BAIR FOUNDATION
Entity Type:Organization
Organization Name:THE BAIR FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-946-8711
Mailing Address - Street 1:241 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1116
Mailing Address - Country:US
Mailing Address - Phone:724-946-8711
Mailing Address - Fax:724-946-3249
Practice Address - Street 1:15 CENTURY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1554
Practice Address - Country:US
Practice Address - Phone:864-281-0058
Practice Address - Fax:864-281-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-1002277001-CPA251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCBT030Medicaid
SCCM1017Medicaid