Provider Demographics
NPI:1093015059
Name:SCARLET HAVEN NURSING CARE, LLC
Entity Type:Organization
Organization Name:SCARLET HAVEN NURSING CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EULA
Authorized Official - Middle Name:KHADIJATU
Authorized Official - Last Name:SECKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-645-7642
Mailing Address - Street 1:12504 LAKE RIDGE DR STE C
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2391
Mailing Address - Country:US
Mailing Address - Phone:703-490-1197
Mailing Address - Fax:703-890-3122
Practice Address - Street 1:12504 LAKE RIDGE DR STE C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2391
Practice Address - Country:US
Practice Address - Phone:703-490-1197
Practice Address - Fax:703-890-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-11694251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health