Provider Demographics
NPI:1104249408
Name:ROYAL HAVEN, LLC
Entity type:Organization
Organization Name:ROYAL HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:818-304-4582
Mailing Address - Street 1:9806 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-1710
Mailing Address - Country:US
Mailing Address - Phone:818-304-4582
Mailing Address - Fax:818-980-3804
Practice Address - Street 1:9806 GERALD AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-1710
Practice Address - Country:US
Practice Address - Phone:818-304-4582
Practice Address - Fax:747-529-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility