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FAIRHAVEN CHRISTIAN RETIREMENT CENTER NPI 1710970926


NPI Information

NPI: 1710970926
Provider Name: FAIRHAVEN CHRISTIAN RETIREMENT CENTER
Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization

CLIA Number: 14D0430401

Address:
3470 N ALPINE RD
ROCKFORD, IL
ZIP 61114
Phone: (815) 877-1441
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FAIRHAVEN CHRISTIAN RETIREMENT CENTER is a nursing facility intermediate care facility in Rockford, IL. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. FAIRHAVEN CHRISTIAN RETIREMENT CENTER NPI is 1710970926. The provider is registered as an organization entity type.

The provider's business location address is:

3470 N ALPINE RD
ROCKFORD, IL
ZIP 61114-802
Phone: (815) 877-1441
Fax: (815) 877-2040

The provider's authorized official is Jeffrey R. Reierson .
The authorized official title is Assistant Admin./dir Of Finance and has the following contact phone number (815) 877-1441.

The CLIA number assigned to this NPI record is 14D0430401 - skilled nursing/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/24/2005 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1313M00000XNursing Facility/Intermediate Care Facility1676858ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10027987MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.