- Enrollment id
- O20220912000190
- Enrollment state
- MA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1417675273
- Multiple npi flag
- N
- Ccn
- 225458
- Associate id
- 4688059751
- Organization name
- VARNUM OPS LLC
- Doing business as name
- FAIRHAVEN HEALTHCARE CENTER
- Incorporation date
- 2021-12-29
- Incorporation state
- MA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- FAIRHAVEN HEALTHCARE CENTER
- Affiliation entity name
- LME FAMILY HOLDINGS
- Affiliation entity id
- 321
- Address line 1
- 476 VARNUM AVE
- City
- LOWELL
- State
- MA
- Zip code
- 018542122