| Name: | Haven Health Center of Warren, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 03 Mar 2003 (22 years ago) |
| Date of Dissolution: | 26 Feb 2009 (16 years ago) |
| Date of Status Change: | 26 Feb 2009 (16 years ago) |
| Branch of: | Haven Health Center of Warren, LLC, CONNECTICUT (Company Number 0728329) |
| Identification Number: | 000130310 |
| Place of Formation: | CONNECTICUT |
| Principal Address: | 245 LONG HILL ROAD, MIDDLETOWN, CT, 06457, USA |
| Purpose: | OWN AND OPERATE NURSING HOMES |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730143199 | 2006-04-13 | 2007-12-28 | 642 METACOM AVE, WARREN, RI, 028852350, US | 642 METACOM AVE, WARREN, RI, 028852350, US | |||||||||||||||||||||||||
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| Phone | +1 401-245-2860 |
| Fax | 4012450959 |
Authorized person
| Name | PAULA BLOOM |
| Role | DIRECTOR OF AR |
| Phone | 8603443884 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | LTC00733 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | HH00733 |
| State | RI |
| Number | Name | File Date |
|---|---|---|
| 200943039460 | Revocation Certificate For Failure to Maintain a Registered Agent | 2009-02-26 |
| 200837999070 | Revocation Notice For Failure to Maintain a Registered Agent | 2008-11-24 |
| 200836448920 | Agent Resigned | 2008-10-16 |
| 200700227710 | Annual Report | 2007-08-21 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 310159546 | 0112300 | 2008-02-21 | 642 METACOM AVENUE, WARREN, RI, 02885 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Citation ID | 01001A |
| Citaton Type | Serious |
| Standard Cited | 19100132 D01 I |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-06-09 |
| Current Penalty | 487.5 |
| Initial Penalty | 975.0 |
| Nr Instances | 7 |
| Nr Exposed | 10 |
| Gravity | 01 |
| Citation ID | 01001B |
| Citaton Type | Serious |
| Standard Cited | 19100151 C |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-06-02 |
| Nr Instances | 2 |
| Nr Exposed | 2 |
| Gravity | 01 |
| Citation ID | 01002 |
| Citaton Type | Serious |
| Standard Cited | 19100303 B01 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Current Penalty | 975.0 |
| Initial Penalty | 975.0 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 01 |
| Citation ID | 01003A |
| Citaton Type | Serious |
| Standard Cited | 19100303 B02 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Current Penalty | 650.0 |
| Initial Penalty | 1300.0 |
| Nr Instances | 2 |
| Nr Exposed | 1 |
| Gravity | 02 |
| Citation ID | 01003B |
| Citaton Type | Serious |
| Standard Cited | 19100304 A02 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Nr Instances | 1 |
| Nr Exposed | 5 |
| Gravity | 02 |
| Citation ID | 01003C |
| Citaton Type | Serious |
| Standard Cited | 19100305 G01 IVA |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Nr Instances | 3 |
| Nr Exposed | 6 |
| Gravity | 02 |
| Citation ID | 01003D |
| Citaton Type | Serious |
| Standard Cited | 19100303 B01 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 01 |
| Citation ID | 01004A |
| Citaton Type | Serious |
| Standard Cited | 19100303 F02 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-16 |
| Current Penalty | 650.0 |
| Initial Penalty | 1300.0 |
| Nr Instances | 1 |
| Nr Exposed | 8 |
| Gravity | 02 |
| Citation ID | 01004B |
| Citaton Type | Serious |
| Standard Cited | 19100303 G01 II |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Nr Instances | 2 |
| Nr Exposed | 3 |
| Gravity | 03 |
| Citation ID | 01004C |
| Citaton Type | Serious |
| Standard Cited | 19100303 G02 I |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Nr Instances | 2 |
| Nr Exposed | 8 |
| Gravity | 01 |
| Citation ID | 01004D |
| Citaton Type | Serious |
| Standard Cited | 19100304 G05 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Nr Instances | 1 |
| Nr Exposed | 2 |
| Gravity | 02 |
| Citation ID | 01005 |
| Citaton Type | Serious |
| Standard Cited | 19100303 G02 I |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Current Penalty | 975.0 |
| Initial Penalty | 975.0 |
| Nr Instances | 2 |
| Nr Exposed | 8 |
| Gravity | 01 |
| Citation ID | 01006 |
| Citaton Type | Serious |
| Standard Cited | 19100304 G05 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-05-23 |
| Current Penalty | 1300.0 |
| Initial Penalty | 1300.0 |
| Nr Instances | 1 |
| Nr Exposed | 2 |
| Gravity | 02 |
| Citation ID | 02001 |
| Citaton Type | Other |
| Standard Cited | 19100038 C05 |
| Issuance Date | 2008-05-13 |
| Abatement Due Date | 2008-06-30 |
| Nr Instances | 3 |
| Nr Exposed | 70 |
| Gravity | 01 |
Date of last update: 10 Apr 2025
Sources: Rhode Island Department of State
