Healthcare Provider Details

I. General information

NPI: 1083726541
Provider Name (Legal Business Name): BELLEPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E ROBINSON ST
NORMAN OK
73071-6614
US

IV. Provider business mailing address

501 E ROBINSON ST
NORMAN OK
73071-6614
US

V. Phone/Fax

Practice location:
  • Phone: 405-329-2655
  • Fax: 405-292-6301
Mailing address:
  • Phone: 405-329-2655
  • Fax: 405-292-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1406
License Number StateOK

VIII. Authorized Official

Name: MR. DAVID THOMPSON
Title or Position: SOLE MEMBER/MANAGER
Credential:
Phone: 405-879-0102