Provider Demographics
NPI:1043887847
Name:FAIRIELD BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:FAIRIELD BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:TEGEMAH
Authorized Official - Last Name:NKWENTI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:614-377-3391
Mailing Address - Street 1:5979 E LIVINGSTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2908
Mailing Address - Country:US
Mailing Address - Phone:614-377-3391
Mailing Address - Fax:614-662-1006
Practice Address - Street 1:5979 E LIVINGSTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2908
Practice Address - Country:US
Practice Address - Phone:614-377-3391
Practice Address - Fax:614-662-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty