Healthcare Provider Details

I. General information

NPI: 1942577960
Provider Name (Legal Business Name): BELLA'S RESERVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 INDUSTRIAL PKWY
SILVER SPRING MD
20904-1998
US

IV. Provider business mailing address

2120 INDUSTRIAL PKWY
SILVER SPRING MD
20904-1998
US

V. Phone/Fax

Practice location:
  • Phone: 301-622-0400
  • Fax: 301-622-4383
Mailing address:
  • Phone: 301-622-0400
  • Fax: 301-622-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN KIM
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 301-622-0400