Provider Demographics
NPI:1023387107
Name:ROYAL HAVEN, INC.
Entity Type:Organization
Organization Name:ROYAL HAVEN, INC.
Other - Org Name:HENRY PLACE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:HOTTEL
Authorized Official - Last Name:JESCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:540-323-7271
Mailing Address - Street 1:1725 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 HENRY AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3153
Practice Address - Country:US
Practice Address - Phone:540-323-7271
Practice Address - Fax:540-323-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVLO-11-181310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility