Healthcare Provider Details

I. General information

NPI: 1083674568
Provider Name (Legal Business Name): FAIR HAVENS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CURTISS PKWY
MIAMI SPRINGS FL
33166-5222
US

IV. Provider business mailing address

201 CURTISS PKWY
MIAMI SPRINGS FL
33166-5222
US

V. Phone/Fax

Practice location:
  • Phone: 305-887-1565
  • Fax:
Mailing address:
  • Phone: 305-887-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1147096
License Number StateFL

VIII. Authorized Official

Name: MR. PHILIP ESFORMES
Title or Position: OWNER
Credential:
Phone: 305-887-1565