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General NPI Number Information
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NPI Number | 1275508970
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Entity Type | Organization
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Legal Business Name | FAIR HAVEN HOME, INC.
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 149 FAIRHAVEN DR
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City | BOSTIC
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State | NC
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Zip | 28018-8759
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Country | US
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Telephone | 828-245-9095
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Fax | 828-245-7856
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Provider Business Mailing Address
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Address Line | 149 FAIRHAVEN DR
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City | BOSTIC
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State | NC
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Zip | 28018-8759
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Country | US
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Telephone | 828-245-9095
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Fax | 828-245-7856
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Authorized Official
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Title or Position | OWNER
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Name | MR. EMMETT JAMES MCKEITHAN
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Credential |
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Telephone | 828-245-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | NH0531
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0531
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License Number State | NC
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