New Haven Manor Home for Adults, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

NEW HAVEN MANOR HOME FOR ADULTS, LLC

Doing business as

New Haven Manor

Practice address

1526 New Haven Ave
Far Rockaway, NY 11691-5148

Phone

(718) 471-7200

NPI assigned

Oct 29, 2020

Organization subpart

No

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

Authorized official

Name

Jennifer Grajales

Title

Project Manager

Phone

(347) 988-4535

Specialties & licenses 1

Addresses

Other names 1

• New Haven Manor Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1346840121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2357 60TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 NEW HAVEN AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116915148",
            "telephone_number": "718-471-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HAVEN MANOR HOME FOR ADULTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "GRAJALES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PROJECT MANAGER",
        "authorized_official_telephone_number": "347-988-4535"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Haven Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Adult Care Home Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.