Provider Demographics
NPI:1477728061
Name:CELEBRITY HAVEN RESIDENTIL CARE FACILITY FOR THE ELDERLY
Entity Type:Organization
Organization Name:CELEBRITY HAVEN RESIDENTIL CARE FACILITY FOR THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:D
Authorized Official - Last Name:EUGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-257-6445
Mailing Address - Street 1:5950 HAIRE LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-9711
Mailing Address - Country:US
Mailing Address - Phone:707-257-6445
Mailing Address - Fax:707-257-0520
Practice Address - Street 1:5950 HAIRE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-9711
Practice Address - Country:US
Practice Address - Phone:707-257-6445
Practice Address - Fax:707-257-0520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CELEBRITY HAVEN RESIDENTIAL CARE FACILITY FOR THE ELDERLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280108992311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home