MEDICARE: BELLO RESIDENTIAL CARE INC

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1508689068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLO RESIDENTIAL CARE INC

Provider Business Mailing Address
First Line	:	1503 VIRGINIA ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-1377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 VIRGINIA ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-1377
Country	:	US
Telephone Number	:	925-922-7264
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AZZIZ SADIQ IKHARO
Credential	:
Telephone Number	:	925-922-7264

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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