Provider Demographics
NPI:1619013208
Name:HAVEN HEALTH CENTER OF CROMWELL
Entity Type:Organization
Organization Name:HAVEN HEALTH CENTER OF CROMWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIERKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-704-8400
Mailing Address - Street 1:385 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2308
Mailing Address - Country:US
Mailing Address - Phone:860-635-5613
Mailing Address - Fax:860-635-6330
Practice Address - Street 1:385 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2308
Practice Address - Country:US
Practice Address - Phone:860-635-5613
Practice Address - Fax:860-635-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1025C313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0091751Medicaid
CT075263Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER