Healthcare Provider Details

I. General information

NPI: 1114987161
Provider Name (Legal Business Name): FAIRVIEW HAVEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N 4TH ST
FAIRBURY IL
61739-1210
US

IV. Provider business mailing address

605 N 4TH ST PO BOX 20
FAIRBURY IL
61739-1210
US

V. Phone/Fax

Practice location:
  • Phone: 815-692-2572
  • Fax: 815-692-4257
Mailing address:
  • Phone: 815-692-2572
  • Fax: 815-692-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0008524
License Number StateIL

VIII. Authorized Official

Name: MR. RICHARD L PLATTNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-692-2572