MEDICARE: BELLA GARDEN LLC

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

General Provider Information

NPI Number	:	1548983869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA GARDEN LLC

Provider Business Mailing Address
First Line	:	22790 VAN BUREN ST
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5700
Country	:	US
Telephone Number	:	909-285-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	22790 VAN BUREN ST
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5700
Country	:	US
Telephone Number	:	909-285-7878
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ELIZABETH COLUNGA
Credential	:
Telephone Number	:	909-285-7878

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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Directions to “BELLA GARDEN LLC ” Practice Location

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