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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