Provider Demographics
NPI:1477812584
Name:BELL, CHARLTON EDWIN
Entity Type:Individual
Prefix:
First Name:CHARLTON
Middle Name:EDWIN
Last Name:BELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 MAPLE TREE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2806
Mailing Address - Country:US
Mailing Address - Phone:904-619-8730
Mailing Address - Fax:904-619-8730
Practice Address - Street 1:7306 MAPLE TREE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2806
Practice Address - Country:US
Practice Address - Phone:904-619-8730
Practice Address - Fax:904-619-8730
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906529311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home