Provider Demographics
NPI:1356339105
Name:HAVEN MANOR HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:HAVEN MANOR HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CYTRYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-471-1500
Mailing Address - Street 1:1441 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-868-0030
Practice Address - Street 1:1441 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4316
Practice Address - Country:US
Practice Address - Phone:718-471-1500
Practice Address - Fax:718-868-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7003378NMedicaid
NY335676Medicare ID - Type Unspecified