Provider Demographics
NPI:1114021250
Name:JUPITER BELLFLOWER DOCTORS HOSPITAL
Entity Type:Organization
Organization Name:JUPITER BELLFLOWER DOCTORS HOSPITAL
Other - Org Name:BELLFLOWER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/HOSPITAL CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-463-8273
Mailing Address - Street 1:9542 EAST ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706
Mailing Address - Country:US
Mailing Address - Phone:562-925-8355
Mailing Address - Fax:949-732-4671
Practice Address - Street 1:9542 EAST ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706
Practice Address - Country:US
Practice Address - Phone:562-925-8355
Practice Address - Fax:949-732-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00899282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40531HMedicaid
CAHSC30531HMedicaid
CAHSM30531HMedicaid
CAHSC30531HMedicaid