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
State | License ID | Taxonomies |
---|---|---|
VA | VLO-11-181 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |