Healthcare Provider Details

I. General information

NPI: 1497936108
Provider Name (Legal Business Name): SALEMHAVEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 GEREMONTY DR
SALEM NH
03079-3314
US

IV. Provider business mailing address

23 GEREMONTY DR
SALEM NH
03079-3314
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-4799
  • Fax: 603-898-6549
Mailing address:
  • Phone: 603-893-4799
  • Fax: 603-898-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number02616
License Number StateNH

VIII. Authorized Official

Name: PAULA FAIST
Title or Position: DIRECTOR
Credential:
Phone: 603-893-4799