Healthcare Provider Details

I. General information

NPI: 1679729834
Provider Name (Legal Business Name): BEL-REGIONAL HOME MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 W RYAN ST SUITE E
BRILLION WI
54110
US

IV. Provider business mailing address

964 W RYAN ST SUITE E
BRILLION WI
54110
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-3242
  • Fax:
Mailing address:
  • Phone: 920-756-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DENISE K STROOBANTS
Title or Position: CLINIC PROVIDER CREDENTIALING
Credential:
Phone: 920-445-7222