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General NPI Number Information
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NPI Number | 1265983076
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Entity Type | Organization
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Legal Business Name | BELLEFAIRE JCB
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 22001 FAIRMOUNT BLVD
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City | SHAKER HTS,.
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State | OH
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Zip | 44118-8919
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Country | US
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Telephone | 216-921-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 22001 FAIRMOUNT BLVD
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City | SHAKER HTS.
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State | OH
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Zip | 44118-4819
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Country | US
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Telephone | 216-921-8000
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ELLEN ROSENBLATT
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Credential |
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Telephone | 216-320-8206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | RN289240
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License Number State | OH
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