| Name: | Haven Health Center of Pawtucket, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 24 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 Pawtucket, LLC, CONNECTICUT (Company Number 0735000) |
| Identification Number: | 000130773 |
| 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 | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659368702 | 2005-10-04 | 2007-12-28 | 70 GILL AVE, PAWTUCKET, RI, 028614315, US | 70 GILL AVE, PAWTUCKET, RI, 028614315, US | |||||||||||||||||||||||||
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| Phone | +1 401-722-7900 |
| Fax | 4017239670 |
Authorized person
| Name | PAULA BLOOM |
| Role | DIRECTOR OF AR |
| Phone | 8603443884 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 31400000X |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | HH513377 |
| State | RI |
| Number | Name | File Date |
|---|---|---|
| 200943039550 | Revocation Certificate For Failure to Maintain a Registered Agent | 2009-02-26 |
| 200837999160 | Revocation Notice For Failure to Maintain a Registered Agent | 2008-11-24 |
| 200836449170 | Agent Resigned | 2008-10-16 |
| 200700227620 | Annual Report | 2007-08-21 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
