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General NPI Number Information
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NPI Number | 1720638521
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Entity Type | Organization
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Legal Business Name | FAIR HAVENS SENIOR LIVING LLC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1790 S FAIRVIEW AVE
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City | DECATUR
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State | IL
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Zip | 62521-4010
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Country | US
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Telephone | 217-429-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 1790 S FAIRVIEW AVE
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City | DECATUR
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State | IL
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Zip | 62521-4010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF AR
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Name | SARAH DUJUA
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Credential |
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Telephone | 630-217-1014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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