Fairlawn Haven

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FAIRLAWN HAVEN

Practice address

407 E Lutz Rd
Archbold, OH 43502-1252

Phone

(419) 445-3074

NPI assigned

Jul 5, 2005

Last updated

Aug 16, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tammy S. Allison

Title

Healthcare Administrator

Phone

(419) 445-3075

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003813148. Details of each certification follow.

• CCN 366290 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 366290

Legal name

FAIRLAWN HAVEN

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 1, 2004

Last certification

Apr 10, 2025

Beds

99

Ownership / control type

Church Related

Organization structure

CorporationNon-profit

Incorporated

Jun 21, 1961 in OH

Enrollment address

407 E Lutz Rd
Archbold, OH 43502-1252

Nursing home name

FAIRLAWN HAVEN

Listed as

Fairlawn HavenCCN 366290 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Church related

Certified

Sep 1, 2004

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9993.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Fairlawn Haven2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Fairlawn Haven

  dba Fairlawn Haven Assisted Living

  • Assisted Living Facility
  • Archbold, OH
  • NPI 1215710678
  NPD tax ID

Locations

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 2

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

• Andrew John Emch, O.D.

  • Optometrist
  • Archbold, OH
  • NPI 1629224738

  Corporate Director

  CMS ownership
• Jacob Lloyd Nafziger, DO

  • Family Medicine Physician
  • Archbold, OH
  • NPI 1992202394

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Fairlawn Haven

  dba Fairlawn Haven Assisted Living

  • Assisted Living Facility
  • Archbold, OH
  • NPI 1215710678
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Denise Nofziger

  • Family Nurse Practitioner
  • Archbold, OH
  • NPI 1609324748
  NPD (past)

Affiliated clinicians 2

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

• Jacob Lloyd Nafziger, DO

  • Family Medicine Physician
  • Archbold, OH
  • NPI 1992202394

  Nursing home

  Care Compare affiliation
• Denise Nofziger

  • Family Nurse Practitioner
  • Archbold, OH
  • NPI 1609324748

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1003813148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E LUTZ RD",
            "city": "ARCHBOLD",
            "state": "OH",
            "postal_code": "435021252",
            "telephone_number": "419-445-3074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E LUTZ RD",
            "city": "ARCHBOLD",
            "state": "OH",
            "postal_code": "435021252",
            "telephone_number": "419-445-3074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLAWN HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "HEALTHCARE ADMINISTRATOR",
        "authorized_official_telephone_number": "419-445-3075"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010302",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Elliott, OTR/L
• Addison Elser
• John D Emch OD
• Andrew John Emch, O.D.
• Everside Health, LLC
• Fairlawn Haven (Fairlawn Haven Assisted Living)
• Kristine Siesel Fauver, ED.D.
• Matthew Christopher Ferguson, M.O.T., OTR/L
• Flame Fitness LLC (Kinesis)
• Jenna Marie Fleming, MOT, OTR

• Skilled Nursing Facility in Archbold, OH
• Providers in Archbold, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.