Provider Demographics
NPI:1144626078
Name:BBW MANAGEMENT GROUP, LLC
Entity type:Organization
Organization Name:BBW MANAGEMENT GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MENDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-484-8888
Mailing Address - Street 1:5308 13TH AVE
Mailing Address - Street 2:STE 273
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1422
Practice Address - Country:US
Practice Address - Phone:636-225-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265130Medicare Oscar/Certification