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General NPI Number Information
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NPI Number | 1538522503
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Entity Type | Organization
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Legal Business Name | SUNHAVEN ASSISTED LIVING
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 2731 JAMAICA BLVD S
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-7770
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Country | US
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Telephone | 928-855-5558
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Fax | 877-632-1956
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Provider Business Mailing Address
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Address Line | 2731 JAMAICA BLVD S
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-7770
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Country | US
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Telephone | 928-855-5558
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Fax | 877-632-1956
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFF SCHALL
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Credential | D.C.
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Telephone | 661-747-1507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL8825C
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License Number State | AZ
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