Provider Demographics
NPI:1376547315
Name:BV GENERAL INC
Entity Type:Organization
Organization Name:BV GENERAL INC
Other - Org Name:LEISURE GLEN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-4476
Mailing Address - Street 1:1505 COLBY DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3307
Mailing Address - Country:US
Mailing Address - Phone:818-247-4476
Mailing Address - Fax:818-247-1776
Practice Address - Street 1:1505 COLBY DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3307
Practice Address - Country:US
Practice Address - Phone:818-247-4476
Practice Address - Fax:818-247-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC05845HMedicaid
CALTC05845HMedicaid