Basic Information
| Provider Information | |||||||||
| NPI: | 1902176522 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STONEHAVEN ASSISTED LIVING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 OLYMPIA DR | ||||||||
| Address2: | |||||||||
| City: | MAUMELLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721136572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018033335 | ||||||||
| FaxNumber: | 5018030303 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 OLYMPIA DR | ||||||||
| Address2: | |||||||||
| City: | MAUMELLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721136572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018033335 | ||||||||
| FaxNumber: | 5018030303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | KEESE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5018033335 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 020 | AR | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.