Provider Demographics
NPI:1649931254
Name:BV PORT JEFFERSON OPERATOR, LLC
Entity type:Organization
Organization Name:BV PORT JEFFERSON OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DUKER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-962-0595
Mailing Address - Street 1:1175 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-802-5021
Mailing Address - Fax:631-802-5022
Practice Address - Street 1:1175 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-802-5021
Practice Address - Fax:631-802-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)