Provider Demographics
NPI:1588382543
Name:BELL AVE SNF OPERATIONS LLC
Entity type:Organization
Organization Name:BELL AVE SNF OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-422-8848
Mailing Address - Street 1:2301 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2254
Mailing Address - Country:US
Mailing Address - Phone:580-225-3335
Mailing Address - Fax:580-309-6016
Practice Address - Street 1:2301 BELL AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2254
Practice Address - Country:US
Practice Address - Phone:580-225-3335
Practice Address - Fax:580-309-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility