Organization
FAIRHAVEN II QUALITY ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL J STODDARD (OWNER)
(505) 763-8100
Entity
Organization
Contact information
Practice address
512 WRANGLER WAY, CLOVIS, NM 88101-2917
(505) 763-8100
Mailing address
200 MURRAY DR, CLOVIS, NM 88101-4349
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
5871
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5871
NMDOH LICENSE NUMBER
NM
Enumeration date
03/19/2007
Last updated
08/22/2020
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