Provider Demographics
NPI:1780096586
Name:REST HAVEN
Entity type:Organization
Organization Name:REST HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-946-9562
Mailing Address - Street 1:686 COUNTY ROAD 370
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:MS
Mailing Address - Zip Code:39330-9727
Mailing Address - Country:US
Mailing Address - Phone:601-274-5308
Mailing Address - Fax:
Practice Address - Street 1:686 COUNTY ROAD 370
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:MS
Practice Address - Zip Code:39330-9727
Practice Address - Country:US
Practice Address - Phone:601-274-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness