Provider Demographics
NPI:1417342494
Name:FAIRHAVENS HOME CARE
Entity Type:Organization
Organization Name:FAIRHAVENS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMEKA LINUS
Authorized Official - Middle Name:CHIKWELU
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-222-4746
Mailing Address - Street 1:2608 87TH TRL N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3742
Mailing Address - Country:US
Mailing Address - Phone:763-222-4746
Mailing Address - Fax:763-888-0075
Practice Address - Street 1:2608 87TH TRL N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3742
Practice Address - Country:US
Practice Address - Phone:763-222-4746
Practice Address - Fax:763-888-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1077353-1-HCBS251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care