Healthcare Provider Details

I. General information

NPI: 1275128860
Provider Name (Legal Business Name): BELLEVUE HEALTHCARE II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 WARBONNET DR
MOSCOW ID
83843-4023
US

IV. Provider business mailing address

2015 152ND AVE NE
REDMOND WA
98052-5521
US

V. Phone/Fax

Practice location:
  • Phone: 208-997-3033
  • Fax:
Mailing address:
  • Phone: 425-451-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JOEL GALLION
Title or Position: PRESIDENT
Credential:
Phone: 425-451-2842