Provider Demographics
NPI:1225411531
Name:NEW HAVEN INC.
Entity Type:Organization
Organization Name:NEW HAVEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-871-2749
Mailing Address - Street 1:3005 BONVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5335
Mailing Address - Country:US
Mailing Address - Phone:301-871-2749
Mailing Address - Fax:
Practice Address - Street 1:3005 BONVIEW LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5335
Practice Address - Country:US
Practice Address - Phone:301-871-2749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL 0504-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility