Provider Demographics
NPI:1649092974
Name:FAIR CHANCE CARE SERVICES
Entity type:Organization
Organization Name:FAIR CHANCE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-648-9768
Mailing Address - Street 1:190 S HIGH ST APT 684
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3682
Mailing Address - Country:US
Mailing Address - Phone:614-648-9768
Mailing Address - Fax:
Practice Address - Street 1:190 S HIGH ST APT 684
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3682
Practice Address - Country:US
Practice Address - Phone:614-648-9768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities