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NPI Code Detail

MEDICARE: HAVEN HEALTH CENTER OF PAWTUCKET, LLC

MEDICARE: HAVEN HEALTH CENTER OF PAWTUCKET, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility31400000XRI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659368702
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAVEN HEALTH CENTER OF PAWTUCKET, LLC
Provider Business Mailing Address
First Line : 70 GILL AVE
Second Line :
City : PAWTUCKET
State : RI
Zip : 02861-4315
Country : US
Telephone Number : 401-722-7900
Fax Number : 401-723-9670
Provider Business Practice Location Address
First Line : 70 GILL AVE
Second Line :
City : PAWTUCKET
State : RI
Zip : 02861-4315
Country : US
Telephone Number : 401-722-7900
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF AR
Name : PAULA BLOOM
Credential :
Telephone Number : 860-344-3884
Provider Enumeration Date : 10/04/2005
Last Update Date : 12/28/2007

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