Provider Demographics
NPI:1740082502
Name:SOUTH HAVEN NH, LLC
Entity type:Organization
Organization Name:SOUTH HAVEN NH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-766-1995
Mailing Address - Street 1:8028 RITCHIE HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-766-1995
Mailing Address - Fax:410-505-1525
Practice Address - Street 1:2700 SOUTHAVEN RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7122
Practice Address - Country:US
Practice Address - Phone:410-766-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility