1669485561 NPI number — BELLCOA HOME HEALTH SERVICE, INC

Table of content: (NPI 1669485561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669485561 NPI number — BELLCOA HOME HEALTH SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLCOA HOME HEALTH SERVICE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669485561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 N. LAMAR BLVD
Provider Second Line Business Mailing Address:
SUITE D-79
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78752-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-533-9990
Provider Business Mailing Address Fax Number:
512-533-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 N. LAMAR BLVD
Provider Second Line Business Practice Location Address:
SUITE D-79
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78752-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-533-9990
Provider Business Practice Location Address Fax Number:
512-533-9992
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLASUPO
Authorized Official First Name:
KOLAWOLE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
512-608-8292

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  17027 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com