Healthcare Provider Details

I. General information

NPI: 1366438491
Provider Name (Legal Business Name): SALEMHAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/12/2012
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: 603-893-5586
  • Fax: 603-893-4394
Mailing address:
  • Phone: 603-893-5586
  • Fax: 603-893-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number02630
License Number StateNH

VIII. Authorized Official

Name: MR. RAYMOND MILLIARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-893-5586