Provider Demographics
NPI:1235251992
Name:NEW HAVEN HEALTH CARE
Entity Type:Organization
Organization Name:NEW HAVEN HEALTH CARE
Other - Org Name:WEST ROCK HEALTH CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TERRANCE
Authorized Official - Last Name:MUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-389-9744
Mailing Address - Street 1:34 LEVEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1017
Mailing Address - Country:US
Mailing Address - Phone:203-389-9744
Mailing Address - Fax:203-389-2856
Practice Address - Street 1:34 LEVEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1017
Practice Address - Country:US
Practice Address - Phone:203-389-9744
Practice Address - Fax:203-389-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2317314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075435Medicare ID - Type UnspecifiedMEDICARE PROVIDER