Provider Demographics
NPI:1902176522
Name:STONEHAVEN ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:STONEHAVEN ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEESE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-803-3335
Mailing Address - Street 1:101 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6572
Mailing Address - Country:US
Mailing Address - Phone:501-803-3335
Mailing Address - Fax:501-803-0303
Practice Address - Street 1:101 OLYMPIA DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6572
Practice Address - Country:US
Practice Address - Phone:501-803-3335
Practice Address - Fax:501-803-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR020310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility