Provider Demographics
NPI:1912982604
Name:HAVEN HEALTH CENTER AT SEACOAST, LLC
Entity Type:Organization
Organization Name:HAVEN HEALTH CENTER AT SEACOAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-344-3884
Mailing Address - Street 1:22 TUCK RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1225
Mailing Address - Country:US
Mailing Address - Phone:603-926-4551
Mailing Address - Fax:603-929-3031
Practice Address - Street 1:22 TUCK RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1225
Practice Address - Country:US
Practice Address - Phone:603-926-4551
Practice Address - Fax:603-929-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02947314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30102995Medicaid
NH305055AMedicare ID - Type UnspecifiedPROVIDER NUMBER