Provider Demographics
NPI:1942735972
Name:RS WILLOW HAVEN ALF INC
Entity Type:Organization
Organization Name:RS WILLOW HAVEN ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-262-7386
Mailing Address - Street 1:1220 NE 207TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2019
Mailing Address - Country:US
Mailing Address - Phone:305-749-6369
Mailing Address - Fax:305-503-7271
Practice Address - Street 1:1220 NE 207TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2019
Practice Address - Country:US
Practice Address - Phone:305-749-6369
Practice Address - Fax:305-503-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10457310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility