Provider Demographics
NPI:1497880231
Name:NEW HAVEN HOME,INC.
Entity Type:Organization
Organization Name:NEW HAVEN HOME,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ALTIZEN
Authorized Official - Last Name:CELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-350-4080
Mailing Address - Street 1:3109 W 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2102
Mailing Address - Country:US
Mailing Address - Phone:907-350-4080
Mailing Address - Fax:907-334-0905
Practice Address - Street 1:4132 W.88TH AVE.#A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502
Practice Address - Country:US
Practice Address - Phone:907-334-0990
Practice Address - Fax:907-334-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100390310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility