Healthcare Provider Details

I. General information

NPI: 1548631310
Provider Name (Legal Business Name): SCARLET HAVEN RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 OLD BRIDGE RD SUITE 100
WOODBRIDGE VA
22192-2743
US

IV. Provider business mailing address

1346 OLD BRIDGE RD SUITE 100
WOODBRIDGE VA
22192-2743
US

V. Phone/Fax

Practice location:
  • Phone: 240-645-7642
  • Fax: 703-890-3160
Mailing address:
  • Phone: 703-490-1197
  • Fax: 703-890-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2371-01-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number2371-01-001
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2371-01-001
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2371-01-001
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2371-01-001
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2371-01-001
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number2371-01-001
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2371-01-001
License Number StateVA

VIII. Authorized Official

Name: MS. EULA KHADIJATU SECKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-645-7642