MEDICARE: B.V. GENERAL, 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	314000000X	Skilled Nursing Facility	970000040	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0556903	OTHER	CA	CLIA ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255338810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.V. GENERAL, INC.

Provider Business Mailing Address
First Line	:	1506 S GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-3316
Country	:	US
Telephone Number	:	181-824-7620
Fax Number	:	181-824-7712

Provider Business Practice Location Address
First Line	:	300 MISSION AVENUE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-3316
Country	:	US
Telephone Number	:	818-247-4476
Fax Number	:	818-247-1776

Authorized Official
Title or Position	:	FINANCIAL CONTROLLER
Name	:	MR. FERNAN PEDRAJA
Credential	:
Telephone Number	:	181-824-7620

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/21/2016

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