FAIRHAVEN CHRISTIAN RETIREMENT CENTER - NPI 1710970926 - Nursing Facility/Intermediate Care Facility in Rockford, IL

Q: What is Fairhaven Christian Retirement Center's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

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About Fairhaven Christian Retirement Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIRHAVEN CHRISTIAN RETIREMENT CENTER (NPI 1710970926) is a healthcare organization registered as a nursing facility/intermediate care facility in Rockford, Illinois and active in the NPI registry since August 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Jeffrey R. Reierson, Assistant Admin./dir Of Finance, as its authorized official.

NPPES Registry Identity

NPI1710970926

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NameFAIRHAVEN CHRISTIAN RETIREMENT CENTER

Location Address3470 N ALPINE RDRockford, IL 61114-4802

Mailing Address3470 N Alpine RdRockford, IL 61114-4802 · (815) 877-1441 · Fax (815) 877-2040

Phone(815) 877-1441

Fax(815) 877-2040

Organization SubpartNo

Authorized OfficialJeffrey R. ReiersonAssistant Admin./dir Of Finance · (815) 877-1441

Enumeration DateAugust 24, 2005

Last NPPES UpdateAugust 22, 2020

✔ NPI 1710970926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

License✔ Licensed in IL · 1676858

Definition

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

3470 N ALPINE RD, Rockford, IL 61114

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Other Identifiers 1

Medicaid0027987IL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0430401

Fairhaven Christian Retirement Center · Rockford, IL

Active · expires Aug 31, 2026

CLIA Number14D0430401

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorJenice M. Storm

Laboratory Phone(815) 877-1441

Laboratory LocationFairhaven Christian Retirement Center3470 N Alpine Road, Rockford, IL 61114

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LOIS HOLMES VATCH M.A./CCC-SLP

Speech-Language Pathologist