Organization
FAIRFIELD ESTATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HOLTZ (CONTROLLER)
(541) 747-3373
Entity
Organization
Contact information
Practice address
315 NORTH MARKET STREET, FAIRFIELD, IL 62837
(618) 842-5875
(618) 842-5870
Mailing address
78 CENTENNIAL LOOP, EUGENE, OR 97401-7900
(541) 747-3373
(541) 747-0673
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
06/26/2007
Last updated
06/24/2008
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