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General NPI Number Information
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NPI Number | 1881730539
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Entity Type | Organization
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Legal Business Name | OAK HAVEN ASSISTED LIVING
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 506 MATTOX RD
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City | GREENVILLE
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State | NC
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Zip | 27834-9107
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Country | US
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Telephone | 252-752-9210
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Fax | 252-752-3610
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Provider Business Mailing Address
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Address Line | PO BOX 1943
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City | GREENVILLE
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State | NC
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Zip | 27835-1943
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Country | US
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Telephone | 252-752-9210
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Fax | 252-752-3610
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Authorized Official
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Title or Position | PARTNER
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Name | MS. SUSAN W SIMMS
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Credential |
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Telephone | 252-560-5595
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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 | HAL074032
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License Number State | NC
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