Provider Demographics
NPI:1326812678
Name:BVP RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:BVP RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNEZERWA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:210-904-5496
Mailing Address - Street 1:143 GRANT ST APT 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2114
Mailing Address - Country:US
Mailing Address - Phone:210-904-5496
Mailing Address - Fax:
Practice Address - Street 1:143 GRANT ST APT 20
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2114
Practice Address - Country:US
Practice Address - Phone:210-904-5496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities