Provider Demographics
NPI:1427191261
Name:FAIR HAVENS INC.
Entity Type:Organization
Organization Name:FAIR HAVENS INC.
Other - Org Name:FAIR HAVENS REST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BJORKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-822-9838
Mailing Address - Street 1:334 MARION RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3104
Mailing Address - Country:US
Mailing Address - Phone:508-947-1660
Mailing Address - Fax:508-946-5420
Practice Address - Street 1:334 MARION RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-3104
Practice Address - Country:US
Practice Address - Phone:508-947-1660
Practice Address - Fax:508-946-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5500087OtherVPN