Provider Demographics
NPI:1992958185
Name:BELLE VISTA RETIREMENT HOME, INC.
Entity type:Organization
Organization Name:BELLE VISTA RETIREMENT HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-587-0880
Mailing Address - Street 1:1453 BELLEAIR RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2356
Mailing Address - Country:US
Mailing Address - Phone:727-587-0880
Mailing Address - Fax:727-588-2397
Practice Address - Street 1:1453 BELLEAIR RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2356
Practice Address - Country:US
Practice Address - Phone:727-587-0880
Practice Address - Fax:727-588-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7261310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL674094403Medicaid