| 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 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
