Healthcare Provider Details

I. General information

NPI: 1811097694
Provider Name (Legal Business Name): BELLEROSE CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BELLEROSE DR
SAN JOSE CA
95128-1701
US

IV. Provider business mailing address

100 BELLEROSE DR
SAN JOSE CA
95128-1701
US

V. Phone/Fax

Practice location:
  • Phone: 408-286-4161
  • Fax: 408-286-6705
Mailing address:
  • Phone: 408-286-4161
  • Fax: 408-286-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN JONATHAN RIVERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-286-4161