Provider Demographics
NPI:1437815552
Name:SAVANNAH RESIDENTIAL HOME LLC
Entity Type:Organization
Organization Name:SAVANNAH RESIDENTIAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:CHEPTOO
Authorized Official - Last Name:KORIR-DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-462-0247
Mailing Address - Street 1:5578 N MORNING SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3879
Mailing Address - Country:US
Mailing Address - Phone:785-462-0247
Mailing Address - Fax:
Practice Address - Street 1:5578 N MORNING SPRING AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3879
Practice Address - Country:US
Practice Address - Phone:785-462-0247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health