Provider Demographics
NPI:1417166547
Name:BELLEVILLE SENIOR SERVICES, LLC
Entity Type:Organization
Organization Name:BELLEVILLE SENIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-751-6000
Mailing Address - Street 1:518 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3345
Mailing Address - Country:US
Mailing Address - Phone:973-751-6000
Mailing Address - Fax:973-751-1190
Practice Address - Street 1:518 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3345
Practice Address - Country:US
Practice Address - Phone:973-751-6000
Practice Address - Fax:973-751-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ308114261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care