1083988463 NPI number — BEL HAVEN CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083988463 NPI number — BEL HAVEN CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEL HAVEN CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083988463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 LINCOLN BLVD # 239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95648-6303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-768-1128
Provider Business Mailing Address Fax Number:
916-585-9149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 N WEBER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93705-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-486-5977
Provider Business Practice Location Address Fax Number:
559-486-5909
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COURTNEY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-768-1128

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  107202480 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 107202480 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107202480 . This is a "DEPT SOCIAL SERVICES - COMMUNITY CARE LICENSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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