Fair Haven Independent and Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

2743R Issued in OH

Legal business name

FAIR HAVEN INDEPENDENT AND ASSISTED LIVING

Practice address

5500 Northfield Rd
Maple Heights, OH 44137-3114

Phone

(818) 522-4166

NPI assigned

Nov 29, 2016

Last updated

Nov 29, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

KEG CONSULTING AND HEALTHCARE LLCAs reported in NPPES

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

Authorized official

Name

Kenneth Goldblatt

Title

President

Phone

(818) 522-4166

Specialties & licenses 1

Addresses

Part of

Fair Haven Independent and Assisted Living

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

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1730622465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 NORTHFIELD RD",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441373114",
            "telephone_number": "818-522-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 NORTHFIELD RD",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441373114",
            "telephone_number": "818-522-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVEN INDEPENDENT AND ASSISTED LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEG CONSULTING AND HEALTHCARE LLC",
        "enumeration_date": "2016-11-29",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "GOLDBLATT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-522-4166"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "2743R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Essence of Home LLC
• Eternal Transportation Enterprises, LLC
• Diamond Rosemary-Lashae Evans
• Emily Evans
• Angela Fenice Everett, RN
• Faithful Care Services LLC
• Family Legacy Health & Wellness Center, LLC
• Tanya Marie Farrow
• Christine A Ferguson, LICDC-LISW
• Tamika Ferrell

• Assisted Living Facility in Maple Heights, OH
• Providers in Maple Heights, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.