Organization
FAIRHAVEN CHRISTIAN RETIREMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY R. REIERSON NHA,CPA (ASSISTANT ADMIN./DIR OF FINANCE)
(815) 877-1441
Entity
Organization
Contact information
Practice address
3470 N ALPINE RD, ROCKFORD, IL 61114-4802
(815) 877-1441
(815) 877-2040
Mailing address
3470 N ALPINE RD, ROCKFORD, IL 61114-4802
(815) 877-1441
(815) 877-2040
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
1676858
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0027987
—
IL
Enumeration date
08/24/2005
Last updated
08/22/2020
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