Healthcare Provider Details

I. General information

NPI: 1013730720
Provider Name (Legal Business Name): LOVING HAVEN RESIDENTIAL ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 BELMONT AVE
HALEDON NJ
07508-1629
US

IV. Provider business mailing address

525 ROUTE 73 N STE 104
MARLTON NJ
08053-3422
US

V. Phone/Fax

Practice location:
  • Phone: 551-202-2573
  • Fax:
Mailing address:
  • Phone: 551-202-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KESHA C BAPTISTE
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 551-202-2573