Provider Demographics
NPI:1255179685
Name:URSULA'S HAVEN ASSISTED LIVING FACILITY, INC
Entity type:Organization
Organization Name:URSULA'S HAVEN ASSISTED LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SCHMIEL-DEGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:954-639-3611
Mailing Address - Street 1:10620 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6852
Mailing Address - Country:US
Mailing Address - Phone:954-732-6246
Mailing Address - Fax:954-990-8860
Practice Address - Street 1:10620 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6852
Practice Address - Country:US
Practice Address - Phone:954-732-6246
Practice Address - Fax:954-990-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility