NPIMap

Organization Active NPI

Fair Havens Christian Home, Inc.

  • Skilled Nursing Facility
  • Decatur, IL
National Provider Identifier
1083630487
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0018143 Issued in IL
Legal business name
FAIR HAVENS CHRISTIAN HOME, INC.
Practice address
1790 S Fairview Ave
Decatur, IL 62521-4010
Phone
(217) 429-2551
Fax
(217) 429-2942
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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

Authorized official

Name
Mrs. Susan McGhee
Title
Chief Financial Officer
Phone
(314) 587-7903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0018143 IL Primary

Addresses

Primary practice location

1790 S Fairview Ave
Decatur, IL 62521-4010

Mailing address

1790 S Fairview Ave
Decatur, IL 62521-4010
Phone (217) 429-2551

Other identifiers 1

IdentifierTypeStateIssuer
50152OtherILBC/BS PROVIDER NUMBER

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1790 S Fairview Ave
Decatur, IL 62521
Phone (217) 429-2551

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1083630487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 S FAIRVIEW AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214010",
            "telephone_number": "217-429-2551",
            "fax_number": "217-429-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 S FAIRVIEW AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214010",
            "telephone_number": "217-429-2551",
            "fax_number": "217-429-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVENS CHRISTIAN HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "MCGHEE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "314-587-7903",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0018143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "50152",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.