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General NPI Number Information
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NPI Number | 1942519723
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Entity Type | Organization
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Legal Business Name | BJ'S HAVEN /BJ'S HAVEN II
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 3934 E 75TH ST 7426 WORLEY AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44105-3800
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Country | US
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Telephone | 216-206-1868
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Fax |
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Provider Business Mailing Address
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Address Line | 7426 WORLEY AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-3835
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Country | US
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Telephone | 216-206-1868
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Fax |
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Authorized Official
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Title or Position | EXECUTOR,TRUSTEE
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Name | BILLIE JEAN MCALLISTER
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Credential |
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Telephone | 216-206-1868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 2679AFH
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License Number State | OH
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