Healthcare Provider Details

I. General information

NPI: 1710419965
Provider Name (Legal Business Name): BUMBLE BEES DREAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CHAPEL PLAZA CT SUITE 11
COLUMBIA MO
65203-6398
US

IV. Provider business mailing address

2011 CHAPEL PLAZA CT SUITE 11
COLUMBIA MO
65203-6398
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-6340
  • Fax:
Mailing address:
  • Phone: 573-445-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: BRENDA FAY BOELTER
Title or Position: OWNER
Credential:
Phone: 573-445-6340