Healthcare Provider Details

I. General information

NPI: 1003623133
Provider Name (Legal Business Name): HAVENCREST REHABILITATION AND HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 COUNTRY CLUB RD
MONONGAHELA PA
15063-1057
US

IV. Provider business mailing address

229 ROUTE 70 FL 2
TOMS RIVER NJ
08755-1026
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSHUA EISEN
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 724-258-3000