Organization
FAIRHAVEN CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GACKSTATTER (DIRECTOR OF HR/BUSINESS SERVICES)
(608) 322-4331
Entity
Organization
Contact information
Practice address
435 W STARIN RD, WHITEWATER, WI 53190-1133
(262) 473-3445
(262) 473-5468
Mailing address
435 W STARIN RD, WHITEWATER, WI 53190-1133
(262) 473-3445
(262) 473-5468
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1039
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20130500
—
WI
Enumeration date
06/17/2005
Last updated
09/01/2020
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