1497151112 NPI number — BELLEFAIRE JCB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497151112 NPI number — BELLEFAIRE JCB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEFAIRE JCB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONARCH BOARDING ACADEMY - NORTH
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497151112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22001 FAIRMOUNT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44118-4819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-932-2800
Provider Business Mailing Address Fax Number:
216-932-6704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22001 FAIRMOUNT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAKER HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44118-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-932-2800
Provider Business Practice Location Address Fax Number:
216-932-6704
Provider Enumeration Date:
11/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
216-320-8221

Provider Taxonomy Codes

  • Taxonomy code: 251X00000X , with the licence number:  12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2055X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2065X , with the licence number: 12-1946 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02447 . This is a "UPIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2419958 . This is a "MRDD - ODJFS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0525337 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2864226 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2847183 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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