Provider Demographics
NPI:1003382987
Name:FAIR HAVENS OPCO LLC
Entity Type:Organization
Organization Name:FAIR HAVENS OPCO LLC
Other - Org Name:MIAMI SPRINGS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-300-3878
Mailing Address - Street 1:201 CURTISS PKWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5222
Mailing Address - Country:US
Mailing Address - Phone:305-887-1565
Mailing Address - Fax:
Practice Address - Street 1:201 CURTISS PKWY
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5222
Practice Address - Country:US
Practice Address - Phone:305-887-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility