Provider Demographics
NPI:1962202226
Name:SENIOR HAVEN PERSONAL CARE CENTER
Entity type:Organization
Organization Name:SENIOR HAVEN PERSONAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIAJIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:502-616-0376
Mailing Address - Street 1:1432 AVOCA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3289
Mailing Address - Country:US
Mailing Address - Phone:502-510-9916
Mailing Address - Fax:
Practice Address - Street 1:1432 AVOCA RIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3289
Practice Address - Country:US
Practice Address - Phone:502-510-9916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization