Provider Demographics
NPI:1588702484
Name:SWELTON HEIGHTS HAVEN
Entity type:Organization
Organization Name:SWELTON HEIGHTS HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:TITUES'JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-446-4924
Mailing Address - Street 1:1321 MCDEARMAN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2640
Mailing Address - Country:US
Mailing Address - Phone:252-446-4924
Mailing Address - Fax:252-446-0612
Practice Address - Street 1:1321 MCDEARMAN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2640
Practice Address - Country:US
Practice Address - Phone:252-446-4924
Practice Address - Fax:252-446-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL064003311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home