Provider Demographics
NPI:1528398914
Name:BELLHAVEN MANAGEMENT LLC
Entity Type:Organization
Organization Name:BELLHAVEN MANAGEMENT LLC
Other - Org Name:BELLHAVEN CENTER FOR REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECTUIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-286-8100
Mailing Address - Street 1:14116 72 AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:631-286-8100
Mailing Address - Fax:718-732-2481
Practice Address - Street 1:110 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719
Practice Address - Country:US
Practice Address - Phone:631-286-8100
Practice Address - Fax:718-732-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01285730Medicaid
NY01449090Medicaid
NY03025216Medicaid
NY01449090Medicaid