| Name: | Haven Health Center of Coventry, 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 Coventry, LLC, CONNECTICUT (Company Number 0730482) |
| Identification Number: | 000130311 |
| 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 | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275506230 | 2006-02-09 | 2007-12-28 | 10 WOODLAND DR, COVENTRY, RI, 028166716, US | 10 WOODLAND DR, COVENTRY, RI, 028166716, US | |||||||||||||||||||||||
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| Phone | +1 401-826-2000 |
Authorized person
| Name | MS. PAULA BLOOM |
| Role | DIRECTOR OF AR |
| Phone | 8603443884 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | HH00732 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | HH00732 |
| State | RI |
| Number | Name | File Date |
|---|---|---|
| 200943039640 | Revocation Certificate For Failure to Maintain a Registered Agent | 2009-02-26 |
| 200837999250 | Revocation Notice For Failure to Maintain a Registered Agent | 2008-11-24 |
| 200836449350 | Agent Resigned | 2008-10-16 |
| 200700227440 | Annual Report | 2007-08-21 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 310157094 | 0112300 | 2007-06-28 | 10 WOODLAND DRIVE, COVENTRY, RI, 02816 | |||||||||||||||||||||||||||||||||||
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| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19101030 D04 IIIA2 |
| Issuance Date | 2007-12-10 |
| Abatement Due Date | 2008-01-07 |
| Current Penalty | 937.5 |
| Initial Penalty | 1875.0 |
| Nr Instances | 3 |
| Nr Exposed | 5 |
| Gravity | 03 |
Date of last update: 10 Apr 2025
Sources: Rhode Island Department of State
