Basic Information
| Provider Information | |||||||||
| NPI: | 1437748720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELLEVILLE HEALTHCARE AND REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 KNAPP ST | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112351006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189423483 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2626 WESLEYAN DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 669352440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855275636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2021 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | FREUND | ||||||||
| AuthorizedOfficialFirstName: | NOCHUM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7189423483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.