Healthcare Provider Details

I. General information

NPI: 1417166547
Provider Name (Legal Business Name): BELLEVILLE SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 WASHINGTON AVE
BELLEVILLE NJ
07109-3345
US

IV. Provider business mailing address

518 WASHINGTON AVE
BELLEVILLE NJ
07109-3345
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-6000
  • Fax: 973-751-1190
Mailing address:
  • Phone: 973-751-6000
  • Fax: 973-751-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number308114
License Number StateNJ

VIII. Authorized Official

Name: MR. JAY KLOUD
Title or Position: CFO
Credential:
Phone: 973-751-6000