Organization
FAIR HAVEN HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EMMETT JAMES MCKEITHAN (OWNER)
(828) 245-9095
Entity
Organization
Contact information
Practice address
149 FAIRHAVEN DR, BOSTIC, NC 28018-8759
(828) 245-9095
(828) 245-7856
Mailing address
149 FAIRHAVEN DR, BOSTIC, NC 28018-8759
(828) 245-9095
(828) 245-7856
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
NH0531
NC
314000000X
Skilled Nursing Facility
Primary
NH0531
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3405425
—
NC
05
—
340602R
—
NC
05
—
7801066
—
NC
Enumeration date
02/17/2006
Last updated
10/13/2011
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