Healthcare Provider Details

I. General information

NPI: 1871804492
Provider Name (Legal Business Name): NEW HAVEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ARBORETUM DR
OSHKOSH WI
54901-2790
US

IV. Provider business mailing address

PO BOX 851
OSHKOSH WI
54903-0851
US

V. Phone/Fax

Practice location:
  • Phone: 920-231-7900
  • Fax:
Mailing address:
  • Phone: 920-231-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberCBRF
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberCBRF
License Number StateWI

VIII. Authorized Official

Name: TIMOTHY BURNS
Title or Position: DIRECTOR
Credential:
Phone: 920-231-7900