Healthcare Provider Details

I. General information

NPI: 1275781478
Provider Name (Legal Business Name): BELL TRACE HEALTH & LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N BELL TRACE CIR
BLOOMINGTON IN
47408-4408
US

IV. Provider business mailing address

725 N BELL TRACE CIR
BLOOMINGTON IN
47408-4408
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-2858
  • Fax:
Mailing address:
  • Phone: 812-323-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number31000192A
License Number StateIN

VIII. Authorized Official

Name: STEPHEN MOORE
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 812-332-2265