Provider Demographics
NPI:1902221062
Name:FAIRFAX PLACE TRANSPORTATION, LLC
Entity type:Organization
Organization Name:FAIRFAX PLACE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:216-795-1363
Mailing Address - Street 1:9014 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2932
Mailing Address - Country:US
Mailing Address - Phone:216-795-1363
Mailing Address - Fax:216-795-8060
Practice Address - Street 1:9014 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2932
Practice Address - Country:US
Practice Address - Phone:216-795-1363
Practice Address - Fax:216-795-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)