MEDICARE: BV 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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376547315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BV GENERAL INC

Provider Business Mailing Address
First Line	:	1505 COLBY DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-3307
Country	:	US
Telephone Number	:	818-247-4476
Fax Number	:	818-247-1776

Provider Business Practice Location Address
First Line	:	1505 COLBY DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-3307
Country	:	US
Telephone Number	:	818-247-4476
Fax Number	:	818-247-1776

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. YOLANDA WISE
Credential	:
Telephone Number	:	818-247-4476

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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