# FAIRHAVEN REST HOME, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962594630
- **Authorized official:** MRS. BARBARA P. MCCALL (ADMINISTRATOR)
- **Authorized official phone:** (304) 522-0032

## Contact information

- **Practice address:** 700 MADISON AVE, HUNTINGTON, WV 25704-2630
- **Practice address phone:** (304) 522-0032
- **Practice address fax:** (304) 522-1481
- **Mailing address:** 700 MADISON AVE, P. O. BOX 2806, HUNTINGTON, WV 25704-2630
- **Mailing address phone:** (304) 522-0032
- **Mailing address fax:** (304) 522-1481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 2 | WV | Yes |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 09/23/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0003341000 | — | WV |