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
1	253J00000X	Foster Care Agency	S002261	OH

General Provider Information

NPI Number	:	1134427222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLEFAIRE JCB

Provider Business Mailing Address
First Line	:	1866 S COMPTON RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2110
Country	:	US
Telephone Number	:	216-932-2800
Fax Number	:	216-320-8739

Provider Business Practice Location Address
First Line	:	1866 S COMPTON RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2110
Country	:	US
Telephone Number	:	216-932-2800
Fax Number	:	216-320-8739

Authorized Official
Title or Position	:	CASE MANAGER
Name	:	MR. ALVA L HALL JR.
Credential	:	LSW
Telephone Number	:	216-320-8472

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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