Provider Demographics
NPI:1952690067
Name:BV ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:BV ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-724-0060
Mailing Address - Street 1:2129 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3875
Mailing Address - Country:US
Mailing Address - Phone:321-724-0060
Mailing Address - Fax:321-724-8157
Practice Address - Street 1:2129 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3875
Practice Address - Country:US
Practice Address - Phone:321-724-0060
Practice Address - Fax:321-724-8157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUENA VIDA ESTATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8693310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility