Provider Demographics
NPI:1740934389
Name:THE FAIRFAX HOUSE INC
Entity type:Organization
Organization Name:THE FAIRFAX HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:TAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-364-4116
Mailing Address - Street 1:6955 FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5643
Mailing Address - Country:US
Mailing Address - Phone:727-364-4116
Mailing Address - Fax:727-843-9501
Practice Address - Street 1:6955 FAIRFAX DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-5643
Practice Address - Country:US
Practice Address - Phone:727-843-9501
Practice Address - Fax:727-843-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care