Provider Demographics
NPI:1639500309
Name:FAIRHAVEN HOLDINGS, LLC
Entity Type:Organization
Organization Name:FAIRHAVEN HOLDINGS, LLC
Other - Org Name:FAIRHAVEN TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-832-9192
Mailing Address - Street 1:890 N HOUSTON LEVEE RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6614
Mailing Address - Country:US
Mailing Address - Phone:901-757-7979
Mailing Address - Fax:901-757-7980
Practice Address - Street 1:890 N HOUSTON LEVEE RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6614
Practice Address - Country:US
Practice Address - Phone:901-757-7979
Practice Address - Fax:901-757-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 261QM0801X, 261QM0850X, 261QM0855X
TN14386251S00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility