Healthcare Provider Details

I. General information

NPI: 1083988463
Provider Name (Legal Business Name): BEL HAVEN CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N WEBER AVE
FRESNO CA
93705-4313
US

IV. Provider business mailing address

69 LINCOLN BLVD # 239
LINCOLN CA
95648-6303
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-5977
  • Fax: 559-486-5909
Mailing address:
  • Phone: 916-768-1128
  • Fax: 916-585-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number107202480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number107202480
License Number StateCA

VIII. Authorized Official

Name: MR. SCOTT COURTNEY
Title or Position: PRESIDENT
Credential:
Phone: 916-768-1128