Provider Demographics
NPI:1265744841
Name:FAIRVIEW HEIGHTS RESIDENTIAL. LLC
Entity type:Organization
Organization Name:FAIRVIEW HEIGHTS RESIDENTIAL. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:375 FOUNTAINS PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2044
Mailing Address - Country:US
Mailing Address - Phone:618-622-9940
Mailing Address - Fax:618-622-9945
Practice Address - Street 1:375 FOUNTAINS PKWY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2044
Practice Address - Country:US
Practice Address - Phone:618-622-9940
Practice Address - Fax:618-622-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility