Healthcare Provider Details

I. General information

NPI: 1447500095
Provider Name (Legal Business Name): THE BELLA PASSIONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 COLORADO BLVD
LOS ANGELES CA
90041-1702
US

IV. Provider business mailing address

488 OAKHAMPTON STREET
THOUSAND OAKS CA
91364
US

V. Phone/Fax

Practice location:
  • Phone: 323-255-0400
  • Fax: 323-255-0177
Mailing address:
  • Phone: 323-255-0400
  • Fax: 323-255-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ESTHER ANN COTTON
Title or Position: BILLING MANAGER
Credential:
Phone: 323-255-0400