Fairhaven Opco, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FAIRHAVEN OPCO, LLC

Doing business as

Madison Park Healthcare

Practice address

700 Madison Ave
Huntington, WV 25704-2630

Phone

(304) 552-0032

Fax

(304) 522-1481

NPI assigned

Dec 31, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Isaac S Dole

Title

Manager

Phone

(312) 724-8950

Specialties & licenses 2

Addresses

Other names 1

• Madison Park Healthcare Doing business as

Tax ID family

Fairhaven Opco LLC2 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.

• Fairhaven Opco, LLC

  dba Madison Park Healthcare

  • Nursing Facility/Intermediate Care Facility
  • Huntington, WV
  • NPI 1295111565
  NPD tax ID

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

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1194180489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S WATER AVE",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370662902",
            "telephone_number": "423-290-2837",
            "fax_number": "888-278-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MADISON AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257042630",
            "telephone_number": "304-552-0032",
            "fax_number": "304-522-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVEN OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "DOLE",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "312-724-8950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Park Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stasha Faddis
• Heather Nichole Fagan, AU.D.
• Elke Fahrmann, MD
• Aaron David Fain, M.D.
• Amanda L Fain, MSW LGSW
• Fairhaven Opco, LLC (Madison Park Healthcare)
• Fairhaven Rest Home, Inc
• Sobia Faisal, M.D
• Mary Heather Fajardo, MA
• Anna Falbo-Freeman, BA

• Physical Therapist in Huntington, WV
• Providers in Huntington, WV by specialty
• Physical Therapist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; 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.