Healthcare Provider Details

I. General information

NPI: 1851142392
Provider Name (Legal Business Name): HAVENS SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SUMMIT BLVD
PENSACOLA FL
32503-3359
US

IV. Provider business mailing address

250 CEDARBRIDGE AVE
LAKEWOOD NJ
08701-4234
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-5900
  • Fax:
Mailing address:
  • Phone: 732-200-1008
  • Fax: 732-201-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SHMUEL ZYTMAN
Title or Position: MANAGING PARTNER
Credential:
Phone: 917-858-9016