Bellefaire JCB
Organization Active NPI Children's Substance Abuse Rehabilitation Facility · Elyria, OH
NPI 1376802249 · NPPES record last updated May 17, 2012
Key facts
- NPI
- 1376802249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Children's Substance Abuse Rehabilitation Facility 3245S0500X
- License
- 0009 (OH)
- Legal business name
- BELLEFAIRE JCB
- Practice address
- 347 Midway Blvd
Elyria, OH 44035-9006 - Phone
- (440) 324-5701
- Fax
- (440) 324-9978
- NPI assigned
- May 11, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- WINGSPAN CARE GROUP
Authorized official
- Name
- Thomas J Browne
- Title
- Cfo
- Phone
- (216) 320-8221
Corporate family (same tax ID) 12
Practitioners 7
-
Jacob D Crosby, LISW, LICDC
-
Lindsey Diane Knoepp, LSW
-
Katelyn Mock, LPC
-
Sara J Ridley, LISW
-
Timothy Scott Schuerr, MSW, LSW
-
Jason Zavodny, LPCC-S
National Provider Directory
- Tax ID family
- Bellefaire Jewish Children'S Bureau
- Part of
- Wingspan Care Group
Locations
347 Midway Blvd
Elyria, OH 44035
Phone (440) 324-5555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 0009 | OH | |
| Substance Abuse Rehabilitation Facility | 324500000X | 0009 | OH | |
| Children's Substance Abuse Rehabilitation Facility | 3245S0500X | 0009 | OH | Yes |
Addresses
Primary practice location
347 Midway Blvd
Elyria, OH 44035-9006
Mailing address
347 Midway Blvd
Elyria, OH 44035-9006
Phone (440) 324-5701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02477 | Medicaid | OH | |
| 10415 | Medicaid | OH |
Other providers in Elyria, OH
- Eugene M Bedocs
- James J. Bedocs
- Virginia Ann Behner
- Hannah Belfeld
- Aracelis Sedonia Bell
- Michael Russell Bellman Jr.
- Ana Elisa Beltran
- Meir Benit
- Amanda Beth Bennett
- Deanna Bennett
All providers in Elyria, OH · Children's Substance Abuse Rehabilitation 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 May 17, 2012. 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.