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Organization
B.V. GENERAL, INC.
Active
Organization
B.V. GENERAL, INC.
Active
Other names
Leisure Glen Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FERNAN PEDRAJA (FINANCIAL CONTROLLER)
(181) 824-7620
Entity
Organization
Contact information
Practice address
300 MISSION AVENUE, GLENDALE, CA 91205-3316
(818) 247-4476
(818) 247-1776
Mailing address
1506 S GLENDALE AVE, GLENDALE, CA 91205-3316
(181) 824-7620
(181) 824-7712
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970000040
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0556903
CLIA ID NUMBER
CA
05
—
LTC05845H
—
CA
Enumeration date
06/28/2005
Last updated
04/21/2016
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