Fairgreen Assisted Living Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11072 Issued in FL

Legal business name

FAIRGREEN ASSISTED LIVING INC.

Practice address

1150 Wayne Ave.
New Smyrna Beach, FL 32168

Phone

(386) 428-3018

Fax

(386) 428-7485

NPI assigned

Sep 13, 2013

Last updated

Sep 13, 2013By 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

Mrs. Jesusa H. Kepler, R.N.

Title

Owner/Administrator

Phone

(386) 428-3018

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379030400000",
    "number": "1184059750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 WAYNE AVE",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686132",
            "telephone_number": "386-428-3018",
            "fax_number": "386-428-7485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 WAYNE AVE.",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "32168",
            "telephone_number": "386-428-3018",
            "fax_number": "386-428-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRGREEN ASSISTED LIVING INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2013-09-13",
        "status": "A",
        "authorized_official_last_name": "KEPLER",
        "authorized_official_first_name": "JESUSA",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "386-428-3018",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1150",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.