Healthcare Provider Details

I. General information

NPI: 1235749557
Provider Name (Legal Business Name): BELLCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2020
Last Update Date: 08/01/2020
Certification Date: 08/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7836 OAKWOOD RD STE A
GLEN BURNIE MD
21061-4298
US

IV. Provider business mailing address

12101 GORDON AVE
BELTSVILLE MD
20705-1173
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-6011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JIMMY AKANBI BELLO
Title or Position: CEO/OWNER
Credential: CRNP
Phone: 301-792-0613