Provider Demographics
NPI:1689132490
Name:FAIRHAVENS HOME CARE LLC
Entity Type:Organization
Organization Name:FAIRHAVENS HOME CARE LLC
Other - Org Name:FAIRHAVENS HOME CARE LLC
Other - Org Type:Doing Business As
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:RN
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:2019-03-11
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care