Healthcare Provider Details

I. General information

NPI: 1851069033
Provider Name (Legal Business Name): BELLA VITA HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 GRANT DR STE A
RENO NV
89509-5369
US

IV. Provider business mailing address

3680 GRANT DR STE A
RENO NV
89509-5369
US

V. Phone/Fax

Practice location:
  • Phone: 775-360-6888
  • Fax: 775-360-6885
Mailing address:
  • Phone: 775-360-6888
  • Fax: 775-360-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROXANNE R. LOPEZ
Title or Position: HOSPICE CARE MANAGER
Credential:
Phone: 775-360-6888