Provider Demographics
NPI:1295446631
Name:FAIRBRANCH HEALTH SERVICES LLC
Entity type:Organization
Organization Name:FAIRBRANCH HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AYOBAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUROSINMI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:512-508-4162
Mailing Address - Street 1:300 E DAVIS ST STE 122
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4588
Mailing Address - Country:US
Mailing Address - Phone:512-508-4162
Mailing Address - Fax:
Practice Address - Street 1:300 E DAVIS ST STE 122
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4588
Practice Address - Country:US
Practice Address - Phone:972-369-7394
Practice Address - Fax:346-515-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty