Bellefaire JCB
Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Shaker Heights, OH
NPI 1093111981 · NPPES record last updated Nov 5, 2014
Key facts
- NPI
- 1093111981
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- License
- 12-2049 (OH)
- Legal business name
- BELLEFAIRE JCB
- Practice address
- 22001 Fairmount Blvd
Shaker Heights, OH 44118-4819 - Phone
- (216) 932-2800
- Fax
- (216) 932-6704
- NPI assigned
- Nov 5, 2014
- Organization subpart
- Yes
- Parent organization (as reported)
- WINGSPAN CARE GROUP
Authorized official
- Name
- Mr. Thomas J Browne
- Title
- Cfo
- Phone
- (216) 320-8221
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- Bellefaire Jewish Children'S Bureau
- Part of
- Wingspan Care Group
Locations
22001 Fairmount Blvd
University Hts, OH 44118
Phone (216) 320-6447
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Supports Brokerage Agency | 251X00000X | 12-2049 | OH | |
| Developmental Disabilities Clinic/Center | 261QD1600X | 12-2049 | OH | |
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | 12-2049 | OH | |
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 12-2049 | OH | Yes |
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 12-2049 | OH | |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | 12-2049 | OH | |
| Psychiatric Residential Treatment Facility | 323P00000X | 12-2049 | OH | |
| Child Mental Illness Respite Care | 385HR2055X | 12-2049 | OH | |
| Child Physical Disabilities Respite Care | 385HR2065X | 12-2049 | OH |
Addresses
Primary practice location
22001 Fairmount Blvd
Shaker Heights, OH 44118-4819
Mailing address
22001 Fairmount Blvd
Shaker Heights, OH 44118-4819
Phone (216) 932-2800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2847183 | Medicaid | OH | |
| 0525337 | Medicaid | OH | |
| 2864226 | Medicaid | OH | |
| 02447 | Other | OH | UPIN |
| 2419958 | Other | OH | MRDD - ODJFS |
Other names
- Monarch Boarding Academy - East
Other providers in Shaker Heights, OH
- Charlotte A Becherer
- Julie Lynn Beckerman
- Allison Mary Begovic
- Mastewal Getaneh Belay
- Kimberly M Bell
- Bellefaire JCB
- Bellefaire JCB
- Bellefaire JCB
- Bellefaire JCB
- Bellefaire Jewish Children'S Bureau
All providers in Shaker Heights, OH · Intellectual and/or Developmental Disabilities Residential Treatment Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.