Organization
FAIR HAVENS SENIOR LIVING LLC
Active
Other names
Fair Havens Senior Living LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH DUJUA (DIRECTOR OF AR)
(630) 217-1014
Entity
Organization
Contact information
Practice address
1790 S FAIRVIEW AVE, DECATUR, IL 62521-4010
(217) 429-2551
Mailing address
1790 S FAIRVIEW AVE, DECATUR, IL 62521-4010
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84296841001
—
IL
Enumeration date
09/13/2019
Last updated
12/31/2024
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