MEDICARE: BEL HAVEN CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	107202480	CA
2	310400000X	Assisted Living Facility	107202480	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107202480	OTHER	CA	DEPT SOCIAL SERVICES - COMMUNITY CARE LICENSING

General Provider Information

NPI Number	:	1083988463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEL HAVEN CARE INC

Provider Business Mailing Address
First Line	:	69 LINCOLN BLVD # 239
Second Line	:
City	:	LINCOLN
State	:	CA
Zip	:	95648-6303
Country	:	US
Telephone Number	:	916-768-1128
Fax Number	:	916-585-9149

Provider Business Practice Location Address
First Line	:	2020 N WEBER AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4313
Country	:	US
Telephone Number	:	559-486-5977
Fax Number	:	559-486-5909

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT COURTNEY
Credential	:
Telephone Number	:	916-768-1128

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	04/25/2013

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Directions to “BEL HAVEN CARE INC ” Practice Location

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