MEDICARE: NEW HAVEN CARE CENTER, INC

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
1	314000000X	Skilled Nursing Facility	030642	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1760479125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HAVEN CARE CENTER, INC

Provider Business Mailing Address
First Line	:	9503 HIGHWAY 100
Second Line	:
City	:	NEW HAVEN
State	:	MO
Zip	:	63068-1300
Country	:	US
Telephone Number	:	573-237-2103
Fax Number	:	573-237-3953

Provider Business Practice Location Address
First Line	:	9503 HIGHWAY 100
Second Line	:
City	:	NEW HAVEN
State	:	MO
Zip	:	63068-1300
Country	:	US
Telephone Number	:	573-237-2103
Fax Number	:	573-237-3953

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DOROTHY MARIE PATAKY
Credential	:	RN, NHA
Telephone Number	:	573-237-2103

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	12/07/2011

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