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General NPI Number Information
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NPI Number | 1114974243
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Entity Type | Organization
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Legal Business Name | PARK HAVEN INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4533 PARK AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-6930
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Country | US
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Telephone | 440-992-9441
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Fax | 440-992-7592
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Provider Business Mailing Address
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Address Line | 2125 W PROSPECT RD
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City | ASHTABULA
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State | OH
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Zip | 44004-6439
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Country | US
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Telephone | 440-992-8387
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Fax | 440-992-7650
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BEATRICE A KNOWLSON
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Credential | RN/LNHA
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Telephone | 440-992-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 6091
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License Number State | OH
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