Provider Demographics
NPI:1750906863
Name:FAIRCHILD, SAPPHIRE R
Entity type:Individual
Prefix:
First Name:SAPPHIRE
Middle Name:R
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 EDGEWOOD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1917
Mailing Address - Country:US
Mailing Address - Phone:860-814-0771
Mailing Address - Fax:
Practice Address - Street 1:470 EDGEWOOD ST FL 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1917
Practice Address - Country:US
Practice Address - Phone:860-814-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1342291OtherSECRETARY OF STATE BUSINESS ID
CTHCA.0001713OtherDEPT OF CONSUMER PROTECTION REGISTERED HOMEMAKER COMPANION AGENCY CERTIFICATE