Salemhaven, Inc.
Organization Active NPI Skilled Nursing Facility · Salem, NH
NPI 1366438491 · NPPES record last updated Jan 12, 2012
Key facts
- NPI
- 1366438491
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 02630 (NH)
- Legal business name
- SALEMHAVEN, INC.
- Practice address
- 23 Geremonty Dr
Salem, NH 03079-3314 - Phone
- (603) 893-5586
- Fax
- (603) 893-4394
- NPI assigned
- Sep 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Raymond Milliard
- Title
- Administrator
- Phone
- (603) 893-5586
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Facilities with the same owner 14
Practitioners 2
Affiliated clinicians 4
-
Anita Kumar, M.D.
-
Victoria Marie Pelletier, MPAS PA-C
Medicare Care Compare: Nursing home
- Listed as
- Salemhaven
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jan 1, 1996
- Medicare certification status
- Active
- Certified beds
- 110 · 88.8 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NH
Skilled nursing facility certification: CCN 305058
- Legal name
- SALEMHAVEN, INC.
- Doing business as
- SALEMHAVEN NURSING HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1996
- Last certification
- Aug 8, 2024
- Beds
- 110
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 1, 1972 in NH
- Enrollment address
- 23 Geremonty Dr
Salem, NH 03079-3314 - Nursing home name
- SALEMHAVEN
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Kathy Murray-Potrin |
Corporate Officer |
Sep 1, 2016 | 100% |
| Corporate Director |
Dec 1, 1979 | 50% | |
| Raymond Milliard |
Contracted Managing Employee |
Apr 3, 2003 | 100% |
| Corporate Director |
Apr 3, 2003 | 100% | |
| Covenant Health |
Operational/Managerial Control | Apr 1, 2001 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120210000217 | NH | Part a Provider - Skilled Nursing Facility | 8123285657 | Practice locations: Salem, NH |
National Provider Directory
- Tax ID family
- Salemhaven Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 02630 | NH | Yes |
Addresses
Primary practice location
23 Geremonty Dr
Salem, NH 03079-3314
Mailing address
23 Geremonty Dr
Salem, NH 03079-3314
Phone (603) 893-5586
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 305058 | Other | NH | ANTHEM BC/BS PROV NUMBER |
| Z46637901 | Other | MA | BC/BS OF MA PROVIDER # |
| 99305036 | Medicaid | NH |
Other names
- Salemhaven Nursing Home
Other providers in Salem, NH
- Salem Radiology LLP
- Salem Radiology LLP
- Salem School District
- Salem Smile Dental Center
- Salemhaven Inc
- Gerriann Samowski
- Christine Gloria Sampson
- Shannon Sanders
- Crystal Sanderson
- Michael F Sandler
All providers in Salem, NH · Skilled Nursing Facility in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.