Fairhavens Home Care

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

License

366358 Issued in MN

Legal business name

FAIRHAVENS HOME CARE

Practice address

2608 87TH TRL N
Brooklyn Park, MN 55443-3742

Phone

(763) 222-4747

NPI assigned

May 15, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Patience Chizoba Okafor

Title

Administrator

Phone

(763) 222-4747

Specialties & licenses 1

Addresses

Tax ID family

Fairhavens Home Care2 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.

• Fairhavens Home Care

  • Nursing Care Agency
  • Brooklyn Park, MN
  • NPI 1417342494
  NPD tax ID

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

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400112000000",
    "number": "1275944936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 87TH TRL N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433742",
            "telephone_number": "763-222-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 87TH TRL N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433742",
            "telephone_number": "763-222-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVENS HOME CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-05-15",
        "status": "A",
        "authorized_official_last_name": "OKAFOR",
        "authorized_official_first_name": "PATIENCE",
        "authorized_official_middle_name": "CHIZOBA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "763-222-4747",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "MN",
            "license": "366358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Skilled Nursing Facility in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Pediatric Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; 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.