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General NPI Number Information
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NPI Number | 1043508419
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Entity Type | Organization
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Legal Business Name | HAVEN SKILLED CARE, LLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 11366 CLEVELAND AVE NW STE B
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City | UNIONTOWN
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State | OH
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Zip | 44685-8078
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Country | US
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Telephone | 330-305-6699
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Fax | 330-305-6856
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Provider Business Mailing Address
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Address Line | 11366 CLEVELAND AVE NW STE B
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City | UNIONTOWN
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State | OH
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Zip | 44685-8078
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Country | US
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Telephone | 330-305-6699
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Fax | 330-305-6856
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN PETRUC
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Credential |
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Telephone | 330-305-6699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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