Provider Demographics
NPI:1457509655
Name:BELL TRACE HEALTH AND LIVING CENTER
Entity Type:Organization
Organization Name:BELL TRACE HEALTH AND LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-332-2265
Mailing Address - Street 1:725 N BELL TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-4408
Mailing Address - Country:US
Mailing Address - Phone:812-323-2858
Mailing Address - Fax:812-323-2854
Practice Address - Street 1:725 N BELL TRACE CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-4408
Practice Address - Country:US
Practice Address - Phone:812-323-2858
Practice Address - Fax:812-323-2854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDON & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002301A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN121332OtherCOMMON ID PIN # FOR ANTHEM
IN358965OtherANTHEM PIN NUMBER