Provider Demographics
NPI:1053129593
Name:CTC FAIRFIELD INC
Entity type:Organization
Organization Name:CTC FAIRFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKLYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-343-2772
Mailing Address - Street 1:96 LINWOOD PLZ STE 303
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3701
Mailing Address - Country:US
Mailing Address - Phone:516-343-2772
Mailing Address - Fax:
Practice Address - Street 1:10178 COUNTY ROAD 550
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8326
Practice Address - Country:US
Practice Address - Phone:740-351-9298
Practice Address - Fax:740-529-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder