Provider Demographics
NPI:1326132507
Name:BELAIRE HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:BELAIRE HEALTH CARE CENTER, INC.
Other - Org Name:BELAIRE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, MFA INC. GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:NOVEL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:540-776-7526
Mailing Address - Street 1:2917 PENN FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4374
Mailing Address - Country:US
Mailing Address - Phone:540-989-3618
Mailing Address - Fax:540-774-9443
Practice Address - Street 1:2065 LYON ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6230
Practice Address - Country:US
Practice Address - Phone:704-867-7300
Practice Address - Fax:704-867-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0561310400000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405457Medicaid
NC340607ZMedicaid
NC7801727OtherREST HOME PROVIDER NUMBER
NC340607ZMedicaid