Provider Demographics
NPI:1881730539
Name:OAK HAVEN ASSISTED LIVING
Entity type:Organization
Organization Name:OAK HAVEN ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-560-5595
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-1943
Mailing Address - Country:US
Mailing Address - Phone:252-752-9210
Mailing Address - Fax:252-752-3610
Practice Address - Street 1:506 MATTOX RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9107
Practice Address - Country:US
Practice Address - Phone:252-752-9210
Practice Address - Fax:252-752-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL074032310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805506Medicaid