Fairchild Home and Community Based Services, LLC
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Billings, OK
NPI 1407240237 · NPPES record last updated Mar 18, 2015
Key facts
- NPI
- 1407240237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- NH5204-5204 (OK)
- Legal business name
- FAIRCHILD HOME AND COMMUNITY BASED SERVICES, LLC
- Practice address
- 205 E Maple
Billings, OK 74630 - Phone
- (580) 725-3400
- Fax
- (580) 725-3402
- NPI assigned
- Mar 18, 2015
- Organization subpart
- No
Authorized official
- Name
- Consuela F Logan, QIDP
- Title
- Administrator
- Phone
- (580) 725-3400
Practitioners 1
-
Jami Luann Benton, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2087356 | Albert Hall | Certificate of waiver | Nov 20, 2026 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | NH5204-5204 | OK | Yes |
Addresses
Primary practice location
205 E Maple
Billings, OK 74630
Mailing address
PO Box 366
205 E Maple
Billings, OK 74630
Phone (580) 725-3400
Other names
- Albert Hall
Other providers in Billings, OK
All providers in Billings, OK · Intellectual Disabilities Intermediate Care Facility in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.