NPIMap

Organization Active NPI

Fair Havens Senior Living LLC

  • Skilled Nursing Facility
  • Decatur, IL
National Provider Identifier
1720638521
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FAIR HAVENS SENIOR LIVING LLC
Doing business as
Fair Havens Senior Living LLC
Practice address
1790 S Fairview Ave
Decatur, IL 62521-4010
Phone
(217) 429-2551
NPI assigned
Sep 13, 2019
Last updated
Dec 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

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

Authorized official

Name
Sarah Dujua
Title
Director of Ar
Phone
(630) 217-1014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1790 S Fairview Ave
Decatur, IL 62521-4010

Mailing address

1790 S Fairview Ave
Decatur, IL 62521-4010

Other identifiers 1

IdentifierTypeStateIssuer
84296841001MedicaidIL

Other names 1

  • Fair Havens Senior Living LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191121002278 IL Part A Provider - Skilled Nursing Facility 1052743523 Practice locations: Decatur, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720638521. Details of each certification follow.

Skilled nursing facility certification: CCN 145422

Legal name
FAIR HAVENS SENIOR LIVING LLC
Doing business as
FAIR HAVENS SENIOR LIVING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1981
Last certification
Aug 15, 2024
Beds
154
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Sheridan Health
Organization structure
LLCProprietary
Enrollment address
1790 S Fairview Ave
Decatur, IL 62521-4010
Nursing home name
FAIR HAVENS SENIOR LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fair Havens Senior LivingCCN 145422 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
15491.6 residents per day on average
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
5Fines totaling $277,416

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Susan Truhlar Individual Corporate Director Apr 4, 2020
Senior Living Holdings LLC Organization, Evanston, IL LLC 5% Or Greater Direct Ownership Interest Oct 1, 2019 100%
Anna Sarah Salazar Dujua Individual Other Apr 4, 2020
Bensenville Holdings LLC Organization, Evanston, IL LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2019 47.5%
John Kern Individual W-2 Managing EmployeeAdministrator Sep 12, 2021
LHCH LLC Organization, Evanston, IL LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2019 47.5%
Atru LLC Organization, Evanston, IL LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2019 5%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1720638521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 S FAIRVIEW AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 S FAIRVIEW AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214010",
            "telephone_number": "217-429-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVENS SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-13",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "DUJUA",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR OF AR",
        "authorized_official_telephone_number": "630-217-1014"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84296841001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair Havens Senior Living LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fair Havens Senior Living LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.