FAIR HAVEN HOME, INC. (NPI# 1275508970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275508970 |
| Entity Type | Organization |
| Organization Name | FAIR HAVEN HOME, INC. |
| Practice Address |
149 Fairhaven Dr Bostic NC 28018-8759 |
| Practice Telephone | 8282459095 |
| Practice Fax Number | 8282457856 |
| Mailing Telephone | 8282459095 |
| Mailing Fax Number | 8282457856 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2011-10-13 |
| Authorized Official Name | MR. EMMETT JAMES MCKEITHAN (OWNER) |
| Authorized Official Telephone | 8282459095 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
NH0531 | NC | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | NH0531 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3405425 | 05 | |
| NC | 7801066 | 05 | |
| NC | 340602R | 05 |
| Street Address |
149 FAIRHAVEN DR |
| City | BOSTIC |
| State | NC |
| Zip Code | 28018-8759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487074399 | Travis Watson Prevette | Occupational Therapist | 149 Fairhaven Dr, Bostic, NC 28018-8759 | 2014-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912229758 | Rutherford County Life Saving & First Aid Crew, Inc | Ambulance | 378 Us Hwy 74, Bostic, NC 28018 | 2010-02-22 |
| 1790842425 | Haven-n-hills Living Center | Assisted Living Facility | 2391 North Carolina Highway 226, Bostic, NC 28018 | 2007-01-02 |
| 1104198639 | Erica Marie O'shall | Occupational Therapy Assistant | 503 South Mountain Rd, Bostic, NC 28018-0577 | 2012-01-30 |
| 1811341985 | Mona Amanda Ray | Registered Nurse | 801 Jonestown Rd, Bostic, NC 28018-7613 | 2016-04-14 |
| 1184057184 | Healthstat On-site Clinic/milliken Golden Valley | Preventive Medicine | 2080 Nc Highway 226, Bostic, NC 28018-7659 | 2013-08-13 |
| 1700075991 | Golden Community Assisted Living LLC | Custodial Care Facility | 2391 Nc Highway 226, Bostic, NC 28018-7661 | 2007-10-23 |
| 1720225709 | Havennhills | Custodial Care Facility | 2391 Nc Highway 226, Bostic, NC 28018-7661 | 2009-01-13 |
| 1326220948 | Golden Community Assisted Living | Assisted Living Facility | 2391 Nc Highway 226, Bostic, NC 28018-7661 | 2007-12-05 |
| 1194118182 | Kristen Downs | Day Training/Habilitation Specialist | 170 Timberlake Rd, Bostic, NC 28018-7807 | 2015-03-15 |
| 1255768503 | Suzanne N Ledford | Counselor | 548 Big Rock Rd, Bostic, NC 28018-7809 | 2013-10-01 |
| Find all providers in zip 28018 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
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| 1558872333 | Brunswick Health & Rehab Center, LLC | Skilled Nursing Facility | 9600 No 5 School Rd Nw, Ash, NC 28420-2122 | 2017-10-19 |
| 1538684212 | Eagle Acquisition Vi LLC | Skilled Nursing Facility | 901 S Halstead Blvd., Elizabeth City, NC 27909-6920 | 2017-08-03 |
| 1982130811 | Ashton Health and Rehabilitation, LLC | Skilled Nursing Facility | 5533 Burlington Rd, Mc Leansville, NC 27301-9622 | 2017-05-11 |
| 1831625037 | Supplemental Healthcare | Skilled Nursing Facility | 319 Vancouver Drive, Apartment 38g, Fayetteville, NC 28303 | 2017-05-08 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.