Fairhaven Christian Retirement Center

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

1676858 Issued in IL

Legal business name

FAIRHAVEN CHRISTIAN RETIREMENT CENTER

Practice address

3470 N Alpine Rd
Rockford, IL 61114-4802

Phone

(815) 877-1441

Fax

(815) 877-2040

NPI assigned

Aug 24, 2005

Organization subpart

No

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

Authorized official

Name

Jeffrey R. Reierson, NHA,CPA

Title

Assistant Admin./Dir of Finance

Phone

(815) 877-1441

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710970926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144802",
            "telephone_number": "815-877-1441",
            "fax_number": "815-877-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3470 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144802",
            "telephone_number": "815-877-1441",
            "fax_number": "815-877-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVEN CHRISTIAN RETIREMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REIERSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "ASSISTANT ADMIN./DIR OF FINANCE",
        "authorized_official_telephone_number": "815-877-1441",
        "authorized_official_credential": "NHA,CPA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "1676858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027987",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in Rockford, IL
• Providers in Rockford, IL by specialty
• Nursing Facility/Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.