NPIMap

Organization Active NPI

Fairhaven Nursing

  • Skilled Nursing Facility
  • Lowell, MA
National Provider Identifier
1639166721
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0177 Issued in MA
Legal business name
FAIRHAVEN NURSING
Practice address
476 Varnum Ave
Lowell, MA 01854-2122
Phone
(978) 458-3388
Fax
(978) 458-6206
NPI assigned
Oct 4, 2005
Last updated
Jul 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

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

Authorized official

Name
Ms. Laura McDonnell
Title
Corporate Business Office Manager
Phone
(978) 420-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0177 MA Primary

Addresses

Primary practice location

476 Varnum Ave
Lowell, MA 01854-2122

Mailing address

476 Varnum Ave
Lowell, MA 01854-2122
Phone (978) 458-3388

Other identifiers 1

IdentifierTypeStateIssuer
0925667MedicaidMA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1639166721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476 VARNUM AVE",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018542122",
            "telephone_number": "978-458-3388",
            "fax_number": "978-458-6206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "476 VARNUM AVE",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018542122",
            "telephone_number": "978-458-3388",
            "fax_number": "978-458-6206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVEN NURSING",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "MCDONNELL",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CORPORATE BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "978-420-1500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0925667",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; 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.