MEDICARE: BELMAR VILLA, LLC

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	310400000X	Assisted Living Facility	107206861	CA

General Provider Information

NPI Number	:	1598169666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELMAR VILLA, LLC

Provider Business Mailing 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	:

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	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARINA ISOUNTS
Credential	:
Telephone Number	:	818-419-9914

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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