Provider Demographics
NPI:1528283892
Name:LOCH HAVEN APARTMENTS
Entity type:Organization
Organization Name:LOCH HAVEN APARTMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN,C
Authorized Official - Phone:660-385-3113
Mailing Address - Street 1:701 SUNSET HILLS DR
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2134
Mailing Address - Country:US
Mailing Address - Phone:660-385-3113
Mailing Address - Fax:
Practice Address - Street 1:701 SUNSET HILLS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2134
Practice Address - Country:US
Practice Address - Phone:660-385-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032683311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO032683OtherRCF LICENSE