Provider Demographics
NPI:1023307451
Name:SAVANNAH ASSISTED LIVING
Entity type:Organization
Organization Name:SAVANNAH ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JICHONAIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-338-0418
Mailing Address - Street 1:8733 LAGRANGE ST
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1630
Mailing Address - Country:US
Mailing Address - Phone:571-338-0418
Mailing Address - Fax:
Practice Address - Street 1:8733 LAGRANGE ST
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1630
Practice Address - Country:US
Practice Address - Phone:571-338-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1054841310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility