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General NPI Number Information
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NPI Number | 1477728061
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Entity Type | Organization
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Legal Business Name | CELEBRITY HAVEN RESIDENTIL CARE FACILITY FOR THE ELDERLY
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 5950 HAIRE LN
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City | NAPA
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State | CA
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Zip | 94559-9711
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Country | US
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Telephone | 707-257-6445
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Fax | 707-257-0520
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Provider Business Mailing Address
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Address Line | 5950 HAIRE LN
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City | NAPA
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State | CA
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Zip | 94559-9711
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Country | US
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Telephone | 707-257-6445
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Fax | 707-257-0520
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | GEMMA D. EUGENIO
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Credential |
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Telephone | 707-257-6445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 280108992
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License Number State | CA
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