Fairfield Community Supports

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

FAIRFIELD COMMUNITY SUPPORTS

Practice address

15663 State Route 595
Logan, OH 43138-8850

Phone

(740) 216-4807

NPI assigned

Sep 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Hoag

Title

Ceo

Phone

(740) 216-4807

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1073128534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15663 STATE ROUTE 595",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431388850",
            "telephone_number": "740-216-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15663 STATE ROUTE 595",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431388850",
            "telephone_number": "740-216-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD COMMUNITY SUPPORTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "HOAG",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "740-216-4807"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0303222",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Embassy Logan, LLC
• Eriksten, LLC.
• Dawn C Evans, LISW
• Dawna Jean Evans, PHARMD, RPH
• Kimberly Everhart
• Fairfield Medical Center
• Pramoda Fatehchand, PA C
• FCS Foundation
• Rebecca Ferguson
• Valerie Sue Ferris

• Developmentally Disabled Services Day Training Agency in Logan, OH
• Providers in Logan, OH by specialty
• Developmentally Disabled Services Day Training Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.