Healthcare Provider Details

I. General information

NPI: 1992290134
Provider Name (Legal Business Name): B&V LA BELLE VIE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 ELDRON BLVD NE
PALM BAY FL
32907-3088
US

IV. Provider business mailing address

193 ELDRON BLVD NE
PALM BAY FL
32907-3088
US

V. Phone/Fax

Practice location:
  • Phone: 321-872-4642
  • Fax: 321-216-3148
Mailing address:
  • Phone: 321-872-4642
  • Fax: 321-216-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: BALAGUEL MEVOICY
Title or Position: ADMIN
Credential:
Phone: 321-872-4642