Provider Demographics
NPI:1780680967
Name:BV GENERAL, INC.
Entity Type:Organization
Organization Name:BV GENERAL, INC.
Other - Org Name:BUENA VENTURA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-6200
Mailing Address - Street 1:1506 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3316
Mailing Address - Country:US
Mailing Address - Phone:818-247-6200
Mailing Address - Fax:818-247-7129
Practice Address - Street 1:1016 S RECORD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2533
Practice Address - Country:US
Practice Address - Phone:323-268-0106
Practice Address - Fax:323-268-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000025314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC05697FMedicaid
CA05D0676352OtherCLIA ID NUMBER
CA05D0676352OtherCLIA ID NUMBER
CA055697Medicare Oscar/Certification