FAIR HAVENS CHRISTIAN HOME, INC. (NPI# 1083630487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083630487 |
| Entity Type | Organization |
| Organization Name | FAIR HAVENS CHRISTIAN HOME, INC. |
| Practice Address |
1790 S Fairview Ave Decatur IL 62521-4010 |
| Practice Telephone | 2174292551 |
| Practice Fax Number | 2174292942 |
| Mailing Telephone | 2174292551 |
| Mailing Fax Number | 2174292942 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2013-12-11 |
| Authorized Official Name | MRS. SUSAN MCGHEE (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 3145877903 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 0018143 | IL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BC/BS PROVIDER NUMBER | 50152 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619276524 | Fair Havens Christian Home, Inc. | Skilled Nursing Facility | 565 W Marion Ave, Forsyth, IL 62535-2099 | 2011-03-17 |
| 1710425509 | Fair Havens Christian Home, Inc. | Clinic/Center | 565 W Marion Ave, Forsyth, IL 62535-2099 | 2017-02-01 |
| 1528219938 | Fair Havens Christian Home, Inc. | Durable Medical Equipment & Medical Supplies | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-10-03 |
| Street Address |
1790 S FAIRVIEW AVE |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-4010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720638521 | Fair Havens Senior Living LLC | Skilled Nursing Facility | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2019-09-13 |
| 1376806836 | Gregory Eugene Hamilton Jr. | Physical Therapist | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2012-06-20 |
| 1154637072 | Michael Warner | Occupational Therapy Assistant | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2010-08-30 |
| 1528219938 | Fair Havens Christian Home, Inc. | Durable Medical Equipment & Medical Supplies | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-10-03 |
| 1659520104 | Cathy J Solomon | Physical Therapist | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-09-09 |
| 1083862478 | Michelle Lynn Dehaai Fletcher | Occupational Therapy Assistant | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-08-28 |
| 1942458351 | Don Eugene Sprague | Physical Therapy Assistant | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-08-28 |
| 1396992723 | Kris Bernardin IIi | Occupational Therapy Assistant | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-08-27 |
| 1013164029 | Tracy Marie Daniels | Occupational Therapy Assistant | 1790 S Fairview Ave, Decatur, IL 62521-4010 | 2008-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
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| 1649722943 | City of Ennis | Skilled Nursing Facility | 701 W Bennett Road, Decatur, TX 76234-3817 | 2016-11-03 |
| 1134458920 | Pruitthealth - Decatur, LLC | Skilled Nursing Facility | 3200 Panthersville Road, Decatur, GA 30034-3831 | 2009-12-08 |
| 1346419397 | Senior Care Resources, Inc. | Skilled Nursing Facility | 701 Bennett Rd, Decatur, TX 76234-3817 | 2008-02-25 |
| 1356476154 | Adams County Memorial Hospital | Skilled Nursing Facility | 1300 Mercer Ave, Decatur, IN 46733-2407 | 2007-02-22 |
| 1417095266 | Lincoln Manor, Inc. | Skilled Nursing Facility | 2650 N Monroe St, Decatur, IL 62526-3251 | 2007-02-02 |
| 1508818766 | Ggnsc Decatur II LLC | Skilled Nursing Facility | 4115 Glenwood Rd, Decatur, GA 30032-4727 | 2006-05-16 |
| 1669424057 | Ggnsc Decatur IIi LLC | Skilled Nursing Facility | 2787 N Decatur Rd, Decatur, GA 30033-5919 | 2006-05-16 |
| 1760432652 | Sunbridge Healthcare LLC | Skilled Nursing Facility | 1350 14th Ave Se, Decatur, AL 35601-4364 | 2006-05-11 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.