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NPI Code Detail

MEDICARE: BELLEFAIRE JCB

MEDICARE: BELLEFAIRE JCB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency01-0009OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952369514
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELLEFAIRE JCB
Provider Business Mailing Address
First Line : 22001 FAIRMOUNT BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44118-4819
Country : US
Telephone Number : 216-320-8222
Fax Number : 216-320-8733
Provider Business Practice Location Address
First Line : 1865 N RIDGE RD E STE D-E
Second Line :
City : LORAIN
State : OH
Zip : 44055-3300
Country : US
Telephone Number : 440-324-5701
Fax Number : 440-277-0459
Authorized Official
Title or Position : GENERAL COUNSEL
Name : LEIGH JOHNSON
Credential :
Telephone Number : 216-320-8222
Provider Enumeration Date : 05/03/2006
Last Update Date : 02/23/2018

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Directions to “BELLEFAIRE JCB ” Practice Location

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