- Enrollment id
- O20181218004150
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1003382987
- Multiple npi flag
- N
- Ccn
- 106128
- Associate id
- 3971848029
- Organization name
- FAIR HAVENS OPCO, LLC
- Doing business as name
- FAIR HAVENS CENTER
- Incorporation date
- 2018-10-12
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MIAMI SPRINGS NURSING AND REHABILITATION CENTER
- Affiliation entity name
- VENTURA SERVICES
- Affiliation entity id
- 860
- Address line 1
- 201 CURTISS PKWY
- City
- MIAMI SPRINGS
- State
- FL
- Zip code
- 331665222