1720517907 NPI number — FAIRCARE HOME HEALTH SERVICES, LLC

Table of content: JAMES ROBERT SKANE RN (NPI 1508231614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720517907 NPI number — FAIRCARE HOME HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRCARE HOME HEALTH SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720517907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6161 BUSCH BLVD STE 85
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43229-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-674-8919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6161 BUSCH BLVD
Provider Second Line Business Practice Location Address:
SUITE 85
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-674-8919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GISLAIN
Authorized Official First Name:
NYOUCHEMBENG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-674-8919

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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