Healthcare Provider Details

I. General information

NPI: 1780504076
Provider Name (Legal Business Name): FAIRHAVEN NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 MAIN ST
FAIRHAVEN MA
02719-3259
US

IV. Provider business mailing address

400 RELLA BLVD STE 200
MONTEBELLO NY
10901-4239
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-3193
  • Fax: 508-564-7412
Mailing address:
  • Phone: 732-600-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AVROHOM ROTBERG
Title or Position: PRESIDENT
Credential:
Phone: 732-600-3946