Healthcare Provider Details

I. General information

NPI: 1528398914
Provider Name (Legal Business Name): BELLHAVEN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BEAVER DAM RD
BROOKHAVEN NY
11719
US

IV. Provider business mailing address

14116 72 AVE
FLUSHING NY
11367
US

V. Phone/Fax

Practice location:
  • Phone: 631-286-8100
  • Fax: 718-732-2481
Mailing address:
  • Phone: 631-286-8100
  • Fax: 718-732-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: CHARLES E GROS
Title or Position: EXECTUIVE DIRECTOR
Credential:
Phone: 631-286-8100