Organization
FAIRHAVEN OPCO, LLC
Active
Other names
Madison Park Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISAAC S DOLE (MANAGER)
(312) 724-8950
Entity
Organization
Contact information
Practice address
700 MADISON AVE, HUNTINGTON, WV 25704-2630
(304) 552-0032
(304) 522-1481
Mailing address
121 S WATER AVE, GALLATIN, TN 37066-2902
(423) 290-2837
(888) 278-3162
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
12/31/2015
Last updated
12/31/2015
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