Provider Demographics
NPI:1689662538
Name:BELLHAVEN CENTER FOR GERIATRIC & REHABILITATIVE CARE INC
Entity type:Organization
Organization Name:BELLHAVEN CENTER FOR GERIATRIC & REHABILITATIVE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-286-8100
Mailing Address - Street 1:110 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9719
Mailing Address - Country:US
Mailing Address - Phone:631-286-8100
Mailing Address - Fax:631-286-8272
Practice Address - Street 1:110 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9719
Practice Address - Country:US
Practice Address - Phone:631-286-8100
Practice Address - Fax:631-286-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5151311N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01285730Medicaid
NY01449090Medicaid
NY01285730Medicaid