Provider Demographics
NPI:1598169872
Name:SCARLET HAVEN ON AGING, LLC
Entity Type:Organization
Organization Name:SCARLET HAVEN ON AGING, LLC
Other - Org Name:SCARLET HAVEN FOR THE AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-490-1197
Mailing Address - Street 1:1346 OLD BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2743
Mailing Address - Country:US
Mailing Address - Phone:703-490-1197
Mailing Address - Fax:703-890-3122
Practice Address - Street 1:1346 OLD BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2743
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:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty