Provider Demographics
NPI:1366438491
Name:SALEMHAVEN, INC.
Entity type:Organization
Organization Name:SALEMHAVEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-893-5586
Mailing Address - Street 1:23 GEREMONTY DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3314
Mailing Address - Country:US
Mailing Address - Phone:603-893-5586
Mailing Address - Fax:603-893-4394
Practice Address - Street 1:23 GEREMONTY DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3314
Practice Address - Country:US
Practice Address - Phone:603-893-5586
Practice Address - Fax:603-893-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02630314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH305058OtherANTHEM BC/BS PROV NUMBER
MAZ46637901OtherBC/BS OF MA PROVIDER #
NH99305036Medicaid
NH305058Medicare Oscar/Certification