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General NPI Number Information
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NPI Number | 1548631310
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Entity Type | Organization
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Legal Business Name | SCARLET HAVEN RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 1346 OLD BRIDGE RD SUITE 100
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2743
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Country | US
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Telephone | 240-645-7642
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Fax | 703-890-3160
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Provider Business Mailing Address
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Address Line | 1346 OLD BRIDGE RD SUITE 100
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2743
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Country | US
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Telephone | 703-490-1197
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Fax | 703-890-3160
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. EULA KHADIJATU SECKA
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Credential |
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Telephone | 240-645-7642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 2371-01-001
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 2371-01-001
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License Number State | VA
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