Provider Demographics
NPI:1548434418
Name:BELLEVUE HAVEN ADULT FAMILY HOME, INC.
Entity type:Organization
Organization Name:BELLEVUE HAVEN ADULT FAMILY HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATIVIDAD
Authorized Official - Middle Name:ALVIZ
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-372-2563
Mailing Address - Street 1:4932 163RD PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4733
Mailing Address - Country:US
Mailing Address - Phone:206-372-2563
Mailing Address - Fax:425-644-2462
Practice Address - Street 1:2202 144TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-6220
Practice Address - Country:US
Practice Address - Phone:425-223-5740
Practice Address - Fax:425-644-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA750002311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home