MEDICARE: FAIR HAVENS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF1147096	FL

General Provider Information

NPI Number	:	1083674568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIR HAVENS CENTER, LLC

Provider Business Mailing Address
First Line	:	201 CURTISS PKWY
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5222
Country	:	US
Telephone Number	:	305-887-1565
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 CURTISS PKWY
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5222
Country	:	US
Telephone Number	:	305-887-1565
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PHILIP ESFORMES
Credential	:
Telephone Number	:	305-887-1565

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/22/2020

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