Provider Demographics
NPI:1619015591
Name:SPRINGHAVEN FCH # 2
Entity Type:Organization
Organization Name:SPRINGHAVEN FCH # 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:TITUES'JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-813-8416
Mailing Address - Street 1:1308 E LANE ST
Mailing Address - Street 2:PO BOX 25718
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2322
Mailing Address - Country:US
Mailing Address - Phone:919-828-3834
Mailing Address - Fax:919-496-3714
Practice Address - Street 1:1308 E LANE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2322
Practice Address - Country:US
Practice Address - Phone:919-828-3834
Practice Address - Fax:919-496-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL092100311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home