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General NPI Number Information
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NPI Number | 1215710678
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Entity Type | Organization
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Legal Business Name | FAIRLAWN HAVEN
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 500 HAVEN DR
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City | ARCHBOLD
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State | OH
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Zip | 43502-1297
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Country | US
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Telephone | 419-445-3075
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Fax | 567-444-5118
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Provider Business Mailing Address
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Address Line | 407 E LUTZ RD
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City | ARCHBOLD
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State | OH
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Zip | 43502-1252
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Country | US
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Telephone | 419-445-3075
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Fax | 567-444-5118
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TAMMY ALLISON
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Credential | LNHA
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Telephone | 567-444-5083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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