Healthcare Provider Details

I. General information

NPI: 1689662538
Provider Name (Legal Business Name): BELLHAVEN CENTER FOR GERIATRIC & REHABILITATIVE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BEAVER DAM RD
BROOKHAVEN NY
11719-9719
US

IV. Provider business mailing address

110 BEAVER DAM RD
BROOKHAVEN NY
11719-9719
US

V. Phone/Fax

Practice location:
  • Phone: 631-286-8100
  • Fax: 631-286-8272
Mailing address:
  • Phone: 631-286-8100
  • Fax: 631-286-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5151311N
License Number StateNY

VIII. Authorized Official

Name: MS. CATHERINE L COFFEY
Title or Position: CONTROLLER
Credential:
Phone: 631-286-8100