MEDICARE: BELL THERAPY INC CSP SOUTH

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	251B00000X	Case Management Agency	1095	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1095	OTHER	WI	STATE CERTIFICATE-LICENSE

General Provider Information

NPI Number	:	1073719548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELL THERAPY INC CSP SOUTH

Provider Business Mailing Address
First Line	:	634 W HISTORIC MITCHELL ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3512
Country	:	US
Telephone Number	:	414-383-4486
Fax Number	:

Provider Business Practice Location Address
First Line	:	634 W HISTORIC MITCHELL ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3512
Country	:	US
Telephone Number	:	414-383-4486
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OUTPATIENT SERVICES
Name	:	ANNE JONES
Credential	:	M.S.
Telephone Number	:	414-871-6122

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/22/2020

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