Provider Demographics
NPI:1730432980
Name:BELLE VISTA BLUFFS, INC.
Entity type:Organization
Organization Name:BELLE VISTA BLUFFS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-587-0887
Mailing Address - Street 1:1138 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4219
Mailing Address - Country:US
Mailing Address - Phone:727-587-0887
Mailing Address - Fax:727-588-2397
Practice Address - Street 1:1138 ROSEMARY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4219
Practice Address - Country:US
Practice Address - Phone:727-587-0887
Practice Address - Fax:727-588-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7261310400000X
FLAL7888310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL674094401Medicaid
FL674094496Medicaid
FL674094403Medicaid