NPIMap

Organization Active NPI

Fair Havens, Inc.

  • Skilled Nursing Facility
  • West Brookfield, MA
National Provider Identifier
1003205667
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FAIR HAVENS, INC.
Practice address
47 E Main St
West Brookfield, MA 01585-2906
Phone
(508) 867-7716
NPI assigned
Jan 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Bovill
Title
President
Phone
(774) 243-3932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

47 E Main St
West Brookfield, MA 01585-2906

Mailing address

14 E Worcester St
Suite 300
Worcester, MA 01604-3612

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150126001796 MA Part A Provider - Skilled Nursing Facility 5193049914 Practice locations: West Brookfield, MA

Skilled nursing facility certification: CCN 225361

Legal name
FAIR HAVENS INC
Doing business as
QUABOAG REHABILITATION AND SKILLED CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1989
Last certification
Apr 24, 2024
Beds
166
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Ascentria Care Alliance
Organization structure
CorporationNon-profit
Enrollment address
47 E Main St
West Brookfield, MA 01585-2906
Nursing home name
QUABOAG REHABILITATION & SKILLED CARE FACILITY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Quaboag Rehabilitation & Skilled Care FacilityCCN 225361
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
166136.9 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Fair Havens Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristin Hanscom Individual Corporate OfficerChief Financial Officer Jan 1, 2024 5%
Adp of the SNF Dec 18, 2024
Keith Robertson Individual Corporate Director Jan 1, 2024 5%
Ascentria Care Alliance Inc Organization, Worcester, MA Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2015 100%
Operational/Managerial Control Feb 1, 2015 100%
Adp of the SNF Jan 29, 2025
Nicholas Sousa Individual Corporate Director Jan 1, 2024 5%
Jessica Macdonald Individual Operational/Managerial Control Nov 1, 2024
Adp of the SNF Nov 1, 2024
Nicholas Russo Individual Corporate OfficerTreasurer Feb 1, 2015 5%
Corporate DirectorDirector Feb 1, 2015 5%
Adp of the SNF Dec 30, 2024
William T Mayo Individual Corporate DirectorDirector Feb 1, 2015 5%
Alexander Bartholomew Individual Corporate Director Jan 1, 2024 5%
Ashish Cowlagi Individual Corporate Director Jan 1, 2024 5%
Ross S Goodman Individual Corporate DirectorDirector Feb 1, 2015 5%
Gary Oneal Individual Corporate Director Jan 1, 2024 5%
Angela B Bovill Individual Corporate OfficerPresident Feb 1, 2015
Corporate DirectorDirector Feb 1, 2015
Adp of the SNF Dec 30, 2024
Christine Tappan Individual Corporate Director Jan 1, 2024 5%
David L Maguire Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Tara Browne Individual Corporate Director Jan 1, 2024 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1003205667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 E WORCESTER ST",
            "address_2": "SUITE 300",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016043612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 E MAIN ST",
            "city": "WEST BROOKFIELD",
            "state": "MA",
            "postal_code": "015852906",
            "telephone_number": "508-867-7716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVENS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "BOVILL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "774-243-3932"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Brookfield, MA

Sources for this page

Verify at the official NPI Registry.