Healthcare Provider Details

I. General information

NPI: 1104439835
Provider Name (Legal Business Name): BELLA-ROUGE HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 OFFICE PARK DR
JACKSON MS
39206-6016
US

IV. Provider business mailing address

PO BOX 70
NATCHEZ MS
39121-0070
US

V. Phone/Fax

Practice location:
  • Phone: 225-433-3172
  • Fax: 601-228-4471
Mailing address:
  • Phone: 225-433-3172
  • Fax: 601-228-4471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BLANCHE MAE BELL
Title or Position: DNP
Credential: NURSE PRACTITIONER
Phone: 305-978-4907