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Organization
FAERIELAND LLC
Active
Organization
FAERIELAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAPPHIRE R FAIRCHILD (MEMBER)
(860) 814-0771
Entity
Organization
Contact information
Practice address
470 EDGEWOOD ST FL 2, HARTFORD, CT 06112-1917
(860) 814-0771
Mailing address
470 EDGEWOOD ST FL 2, HARTFORD, CT 06112-1917
(860) 814-0771
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
04/24/2020
Last updated
06/14/2020
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