NPIMap

Organization Active NPI

Park Haven Inc

  • Nursing Facility/Intermediate Care Facility
  • Ashtabula, OH
National Provider Identifier
1114974243
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
6091 Issued in OH
Legal business name
PARK HAVEN INC
Practice address
4533 Park Ave
Ashtabula, OH 44004-6930
Phone
(440) 992-9441
Fax
(440) 992-7592
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Beatrice A Knowlson, RN/LNHA
Title
Owner
Phone
(440) 992-8387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 6091 OH Primary

Addresses

Primary practice location

4533 Park Ave
Ashtabula, OH 44004-6930

Mailing address

2125 W Prospect Rd
Ashtabula, OH 44004-6439
Phone (440) 992-8387

Other identifiers 1

IdentifierTypeStateIssuer
0242553MedicaidOH

Other names 1

  • Park Haven Home Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114974243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 W PROSPECT RD",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046439",
            "telephone_number": "440-992-8387",
            "fax_number": "440-992-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4533 PARK AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046930",
            "telephone_number": "440-992-9441",
            "fax_number": "440-992-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK HAVEN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KNOWLSON",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-992-8387",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN/LNHA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OH",
            "license": "6091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0242553",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Haven Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashtabula, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.