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General NPI Number Information
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NPI Number | 1528398914
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Entity Type | Organization
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Legal Business Name | BELLHAVEN MANAGEMENT LLC
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 110 BEAVER DAM RD
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City | BROOKHAVEN
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State | NY
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Zip | 11719
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Country | US
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Telephone | 631-286-8100
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Fax | 718-732-2481
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Provider Business Mailing Address
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Address Line | 14116 72 AVE
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 631-286-8100
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Fax | 718-732-2481
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Authorized Official
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Title or Position | EXECTUIVE DIRECTOR
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Name | CHARLES E GROS
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Credential |
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Telephone | 631-286-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | NY
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