Fairway Behavioral Health, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

FAIRWAY BEHAVIORAL HEALTH, LLC

Practice address

140 Fairway Dr
Wilmington, OH 45177-8008

Phone

(937) 992-1057

NPI assigned

Apr 20, 2022

Last updated

Apr 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Polly Vaughan, NPNPI 1063609287

Title

Ceo

Phone

(937) 838-9550

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• 333 Therapeutics Consulting LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eaton, OH
  • NPI 1689209009

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Polly S Vaughan, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Wilmington, OH
  • NPI 1063609287
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1780328344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 FAIRWAY DR",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451778008",
            "telephone_number": "937-992-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 FAIRWAY DR",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451778008",
            "telephone_number": "937-992-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-838-9550",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaime Lynn Evanshine, CNP
• Extended Family Home Health Services LLC
• Eye Services LLC
• Eye Specialist Inc
• Carrie B Fairchild, PA
• Falcon Pharmacy Investments LLC (Barr's Pharmacy of Wilmington)
• Marie Therese Falgner
• Caitlyn Schlie Fannin, CNP
• Morgan Mackenzie Farley, DPT
• Brianna Farr, SWT

• Psychiatric/Mental Health Nurse Practitioner in Wilmington, OH
• Providers in Wilmington, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.