Organization
FAIR HAVENS CHRISTIAN HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN MCGHEE (CHIEF FINANCIAL OFFICER)
(314) 587-7903
Entity
Organization
Contact information
Practice address
1790 S FAIRVIEW AVE, DECATUR, IL 62521-4010
(217) 429-2551
(217) 429-2942
Mailing address
1790 S FAIRVIEW AVE, DECATUR, IL 62521-4010
(217) 429-2551
(217) 429-2942
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0018143
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50152
BC/BS PROVIDER NUMBER
IL
Enumeration date
07/15/2006
Last updated
12/11/2013
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