Healthcare Provider Details

I. General information

NPI: 1376538256
Provider Name (Legal Business Name): BVCV OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 BUENA VISTA STREET
DUARTE CA
91010
US

IV. Provider business mailing address

802 BUENA VISTA STREET
DUARTE CA
91010
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-8141
  • Fax: 626-359-8144
Mailing address:
  • Phone: 626-359-8141
  • Fax: 310-574-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000017
License Number StateCA

VIII. Authorized Official

Name: JACOB WINTNER
Title or Position: MANAGER
Credential:
Phone: 323-651-1808