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Organization
FAIRWAY BEHAVIORAL HEALTH, LLC
Active
Organization
FAIRWAY BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POLLY VAUGHAN NP (CEO)
(937) 838-9550
Entity
Organization
Contact information
Practice address
140 FAIRWAY DR, WILMINGTON, OH 45177-8008
(937) 992-1057
Mailing address
140 FAIRWAY DR, WILMINGTON, OH 45177-8008
(937) 992-1057
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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