Provider Demographics
NPI:1962180265
Name:BELLEFONTAINE HEALTH CENTER LLC
Entity type:Organization
Organization Name:BELLEFONTAINE HEALTH CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHONOCH
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-853-5760
Mailing Address - Street 1:6442 COLDWATER CANYON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1191
Mailing Address - Country:US
Mailing Address - Phone:818-853-5760
Mailing Address - Fax:
Practice Address - Street 1:120 BELLEFONTAINE ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3102
Practice Address - Country:US
Practice Address - Phone:626-793-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility