Provider Demographics
NPI:1235278318
Name:FAIRFIELD CO. BOARD OF MRDD
Entity type:Organization
Organization Name:FAIRFIELD CO. BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-7244
Mailing Address - Street 1:795 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1082
Mailing Address - Country:US
Mailing Address - Phone:740-687-7244
Mailing Address - Fax:740-687-7250
Practice Address - Street 1:795 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1082
Practice Address - Country:US
Practice Address - Phone:740-687-7244
Practice Address - Fax:740-687-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776076Medicaid