# PRIME LUXURY HAVEN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prime Luxury Haven
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427737584
- **Authorized official:** MR. AKIN OBISESAN (DIRECTOR)
- **Authorized official phone:** (718) 925-7080

## Contact information

- **Practice address:** 18 2ND ST, NEWARK, NJ 07107-4429
- **Practice address phone:** (718) 925-7080
- **Mailing address:** 18 2ND ST, NEWARK, NJ 07107-4429
- **Mailing address phone:** (718) 925-7080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261QA0600X | Adult Day Care Clinic/Center | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | — |
| 311Z00000X | Custodial Care Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | — |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 07/17/2023
- **Last updated:** 07/17/2023