Provider Demographics
NPI:1285956268
Name:BEL HAVEN CARE LLC
Entity type:Organization
Organization Name:BEL HAVEN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MILNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-486-5977
Mailing Address - Street 1:2020 N WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4313
Mailing Address - Country:US
Mailing Address - Phone:559-486-5977
Mailing Address - Fax:559-486-5909
Practice Address - Street 1:2020 N WEBER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4313
Practice Address - Country:US
Practice Address - Phone:559-486-5977
Practice Address - Fax:559-486-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107203325310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107203325OtherCOMMUNITY CARE LICENSING