MEDICARE: BJ'S HAVEN /BJ'S HAVEN II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	2679AFH	OH

General Provider Information

NPI Number	:	1942519723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJ'S HAVEN /BJ'S HAVEN II

Provider Business Mailing Address
First Line	:	7426 WORLEY AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3835
Country	:	US
Telephone Number	:	216-206-1868
Fax Number	:

Provider Business Practice Location Address
First Line	:	3934 E 75TH ST
Second Line	:	7426 WORLEY AVENUE
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3800
Country	:	US
Telephone Number	:	216-206-1868
Fax Number	:

Authorized Official
Title or Position	:	EXECUTOR,TRUSTEE
Name	:	BILLIE JEAN MCALLISTER
Credential	:
Telephone Number	:	216-206-1868

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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Directions to “BJ'S HAVEN /BJ'S HAVEN II ” Practice Location

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