Provider Demographics
NPI:1346730298
Name:BV LAKE TAPPAN OPERATOR LLC
Entity Type:Organization
Organization Name:BV LAKE TAPPAN OPERATOR LLC
Other - Org Name:BRIGHTVIEW LAKE TAPPAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BV LAKE TAPPAN OPERATOR LLC BY MARI
Authorized Official - Prefix:
Authorized Official - First Name:MARILYNN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-962-0595
Mailing Address - Street 1:31 HUNT ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-474-2050
Mailing Address - Fax:845-458-8271
Practice Address - Street 1:31 HUNT ROAD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:845-474-2050
Practice Address - Fax:845-458-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)