Healthcare Provider Details

I. General information

NPI: 1780680967
Provider Name (Legal Business Name): BV GENERAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S RECORD AVE
LOS ANGELES CA
90023-2533
US

IV. Provider business mailing address

1506 S GLENDALE AVE
GLENDALE CA
91205-3316
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-0106
  • Fax: 323-268-2010
Mailing address:
  • Phone: 818-247-6200
  • Fax: 818-247-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000025
License Number StateCA

VIII. Authorized Official

Name: MR. EDWARD KEH
Title or Position: MEMBER
Credential:
Phone: 818-247-6200