Healthcare Provider Details

I. General information

NPI: 1730143199
Provider Name (Legal Business Name): HAVEN HEALTH CENTER OF WARREN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 METACOM AVE
WARREN RI
02885-2350
US

IV. Provider business mailing address

642 METACOM AVE
WARREN RI
02885-2350
US

V. Phone/Fax

Practice location:
  • Phone: 401-245-2860
  • Fax: 401-245-0959
Mailing address:
  • Phone: 401-245-2860
  • Fax: 401-245-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTC00733
License Number StateRI

VIII. Authorized Official

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