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NPI Code Detail

MEDICARE: HAVEN HEALTH CENTER OF SOUTH WINDSOR, LLC

MEDICARE: HAVEN HEALTH CENTER OF SOUTH WINDSOR, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility2271CT

General Provider Information

NPI Number : 1588651459
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAVEN HEALTH CENTER OF SOUTH WINDSOR, LLC
Provider Business Mailing Address
First Line : 1060 MAIN ST
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2407
Country : US
Telephone Number : 860-289-7771
Fax Number : 860-289-3761
Provider Business Practice Location Address
First Line : 1060 MAIN ST
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2407
Country : US
Telephone Number : 860-289-7771
Fax Number : 860-289-3761
Authorized Official
Title or Position : DIRECTOR OF AR
Name : PAULA BLOOM
Credential :
Telephone Number : 860-344-3884
Provider Enumeration Date : 10/05/2005
Last Update Date : 12/28/2007

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Directions to “HAVEN HEALTH CENTER OF SOUTH WINDSOR, LLC ” Practice Location

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