Oak Haven Residential Care LLC
Organization Active NPI Assisted Living Facility · Cloverdale, OH
NPI 1780280560 · NPPES record last updated Dec 8, 2020
Key facts
- NPI
- 1780280560
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- Legal business name
- OAK HAVEN RESIDENTIAL CARE LLC
- Practice address
- 152 Main St
Cloverdale, OH 45827-9778 - Phone
- (419) 488-2310
- Fax
- (419) 488-2321
- NPI assigned
- Dec 8, 2020
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sherry Kaye Webb, LPN
- Title
- Administrator
- Phone
- (419) 615-3357
Corporate family (same tax ID) 1
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2273945 | Oak Haven Residential Care Center | Certificate of waiver | Dec 20, 2026 |
National Provider Directory
- Tax ID family
- Oak Haven Residential Care Center LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | Yes |
Addresses
Primary practice location
152 Main St
Cloverdale, OH 45827-9778
Mailing address
PO Box 86
Cloverdale, OH 45827-0086
Phone (419) 488-2310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0109295 | Medicaid | OH |
Other providers in Cloverdale, OH
- Julia Ann Burgei
- Stephanie Coble
- McKenzie Dangler
- Angela Elaine Gamble
- Chandler Quade Hopkins
- Nicole Lee Orwick
- Lana M Shirey
- Taylor Nicole Tucker
- Dana Wallace
- Sherry Webb
All providers in Cloverdale, OH · Assisted Living Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.