MEDICARE: BELLA ROSE HEALTHCARE L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PCH012233	OTHER	GA	DEPARTMENT OF COMMUNITY HEALTH

General Provider Information

NPI Number	:	1053180349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA ROSE HEALTHCARE L.L.C.

Provider Business Mailing Address
First Line	:	7661 KAYNE BLVD STE A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2546
Country	:	US
Telephone Number	:	706-221-3520
Fax Number	:	706-221-3522

Provider Business Practice Location Address
First Line	:	7661 KAYNE BLVD STE A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2546
Country	:	US
Telephone Number	:	706-221-3520
Fax Number	:	706-221-3522

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	ANTIONETTE MUNDY
Credential	:	LPN, LTC ADMIN
Telephone Number	:	762-822-9567

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	12/27/2023

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Directions to “BELLA ROSE HEALTHCARE L.L.C. ” Practice Location

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