Provider Demographics
NPI:1235325408
Name:ST THERESE'S HAVEN
Entity Type:Organization
Organization Name:ST THERESE'S HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-806-2031
Mailing Address - Street 1:8520 SUNRISE WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8520 SUNRISE WOODS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-5360
Practice Address - Country:US
Practice Address - Phone:916-689-8109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness