Healthcare Provider Details

I. General information

NPI: 1588651459
Provider Name (Legal Business Name): HAVEN HEALTH CENTER OF SOUTH WINDSOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 MAIN ST
SOUTH WINDSOR CT
06074-2407
US

IV. Provider business mailing address

1060 MAIN ST
SOUTH WINDSOR CT
06074-2407
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-7771
  • Fax: 860-289-3761
Mailing address:
  • Phone: 860-289-7771
  • Fax: 860-289-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2271
License Number StateCT

VIII. Authorized Official

Name: PAULA BLOOM
Title or Position: DIRECTOR OF AR
Credential:
Phone: 860-344-3884