Provider Demographics
NPI:1255338810
Name:B.V. GENERAL, INC.
Entity type:Organization
Organization Name:B.V. GENERAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:181-824-7620
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:181-824-7620
Mailing Address - Fax:181-824-7712
Practice Address - Street 1:300 MISSION AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3316
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:2005-06-28
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970000040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0556903OtherCLIA ID NUMBER
CALTC05845HMedicaid
CA05D0556903OtherCLIA ID NUMBER
CA055845Medicare Oscar/Certification