Provider Demographics
NPI:1548631310
Name:SCARLET HAVEN RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:SCARLET HAVEN RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EULA
Authorized Official - Middle Name:KHADIJATU
Authorized Official - Last Name:SECKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-645-7642
Mailing Address - Street 1:1346 OLD BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2743
Mailing Address - Country:US
Mailing Address - Phone:703-490-1197
Mailing Address - Fax:703-890-3160
Practice Address - Street 1:1346 OLD BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2743
Practice Address - Country:US
Practice Address - Phone:240-645-7642
Practice Address - Fax:703-890-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2371-01-001251F00000X, 251J00000X, 251S00000X, 253Z00000X, 314000000X, 343900000X, 251C00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2371-01-001OtherDBHDS
VA2371OtherDBHDS