Organization
FAIRHAVEN OPCO, LLC
Active
Other names
Madison Park Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
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
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Enumeration date
08/10/2015
Last updated
12/12/2015
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