Provider Demographics
NPI:1821007436
Name:HAVEN CONVALESCENT HOME, INC.
Entity Type:Organization
Organization Name:HAVEN CONVALESCENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:724-654-8833
Mailing Address - Street 1:725 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4257
Mailing Address - Country:US
Mailing Address - Phone:724-654-8833
Mailing Address - Fax:724-652-9033
Practice Address - Street 1:725 PAUL ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4257
Practice Address - Country:US
Practice Address - Phone:724-654-8833
Practice Address - Fax:724-652-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA081102313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007510350001Medicaid
PA396106Medicare ID - Type Unspecified