Provider Demographics
NPI:1740878859
Name:GLOBAL FAIRLAND LLC
Entity type:Organization
Organization Name:GLOBAL FAIRLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF SELECTIS MANAGEMENT, LLC
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-449-2100
Mailing Address - Street 1:12 E CONNER AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74343-0000
Mailing Address - Country:US
Mailing Address - Phone:918-676-3685
Mailing Address - Fax:918-676-3008
Practice Address - Street 1:12 E CONNER AVE
Practice Address - Street 2:
Practice Address - City:FAIRLAND
Practice Address - State:OK
Practice Address - Zip Code:74343-0000
Practice Address - Country:US
Practice Address - Phone:918-676-3685
Practice Address - Fax:918-676-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility