Fairview Fellowship Home for Senior Citizens, Inc.
Organization Active NPI Nursing Facility/Intermediate Care Facility · Fairview, OK
NPI 1568469740 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1568469740
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- NH4701 (OK)
- Legal business name
- FAIRVIEW FELLOWSHIP HOME FOR SENIOR CITIZENS, INC.
- Practice address
- 605 E State Rd
Fairview, OK 73737-1455 - Phone
- (580) 227-3783
- Fax
- (580) 227-3328
- NPI assigned
- Jul 4, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael G Miller, NHA
- Title
- Executive Director
- Phone
- (580) 227-3783
Practitioners 2
-
Jami Luann Benton, M.D.
-
John Price, M.D.
Affiliated clinicians 2
-
Jami Luann Benton, M.D.
-
John Price, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Fairview Fellowship Home For Senior Citizens, Inc
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jan 31, 2003
- Medicare certification status
- Active
- Certified beds
- 100 · 69.4 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $18,415
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D0472663 | Fairview Fellowship Home | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Skilled nursing facility certification: CCN 375427
- Legal name
- FAIRVIEW FELLOWSHIP HOME FOR SENIOR CITIZENS INC
- Doing business as
- FAIRVIEW FELLOWSHIP HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 31, 2003
- Last certification
- May 23, 2024
- Beds
- 100
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 11, 1960 in OK
- Enrollment address
- 605E State Rd
Fairview, OK 73737-1455 - Nursing home name
- FAIRVIEW FELLOWSHIP HOME FOR SENIOR CITIZENS, INC
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Clay Kliewer |
Corporate Officer | Mar 27, 2012 | |
| Lucille Marie Dykes |
W-2 Managing Employee |
Jun 11, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021106000007 | OK | Part a Provider - Skilled Nursing Facility | 7416865894 | Practice locations: Fairview, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | NH4701 | OK | Yes |
| Skilled Nursing Facility | 314000000X | NH4701 | OK |
Addresses
Primary practice location
605 E State Rd
Fairview, OK 73737-1455
Mailing address
605 E State Rd
Fairview, OK 73737-1455
Phone (580) 227-3783
Other names
- Fairview Fellowship Home and Village
Other providers in Fairview, OK
- Kaci Ranae Edwards
- Larry Shane Elliott
- Entrust DPC PLLC
- Megan Leigh Ewing
- Fairview Family & Sports Chiropractic, P.C.
- Fairview Regional Medical Center
- Fairview Regional Medical Center Authority
- Fairview Regional Medical Center Authority
- Fairview Regional Medical Center Authority
- Fairview Regional Medical Center Authority
All providers in Fairview, OK · Nursing Facility/Intermediate Care Facility in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.