Provider Demographics
NPI:1992290134
Name:B&V LA BELLE VIE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:B&V LA BELLE VIE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BALAGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEVOICY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-872-4642
Mailing Address - Street 1:193 ELDRON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3088
Mailing Address - Country:US
Mailing Address - Phone:321-872-4642
Mailing Address - Fax:321-216-3148
Practice Address - Street 1:193 ELDRON BLVD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3088
Practice Address - Country:US
Practice Address - Phone:321-872-4642
Practice Address - Fax:321-216-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008552300Medicaid