Provider Demographics
NPI:1043834666
Name:JEUNE&BELLE MEDICAL CENTER AND SPA
Entity Type:Organization
Organization Name:JEUNE&BELLE MEDICAL CENTER AND SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:561-254-7933
Mailing Address - Street 1:8987 BIDDLE CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6436
Mailing Address - Country:US
Mailing Address - Phone:561-254-7933
Mailing Address - Fax:561-254-7933
Practice Address - Street 1:13005 SOUTHERN BLVD STE 214
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9272
Practice Address - Country:US
Practice Address - Phone:561-254-7933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1356418875OtherCIGNA
FL1356418875Medicaid