Healthcare Provider Details

I. General information

NPI: 1699152892
Provider Name (Legal Business Name): D BELLMORE CONSTRUCTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 COPRINUS CT
GREEN BAY WI
54313-4208
US

IV. Provider business mailing address

1070 COPRINUS CT
GREEN BAY WI
54313-4208
US

V. Phone/Fax

Practice location:
  • Phone: 920-434-8181
  • Fax:
Mailing address:
  • Phone: 920-434-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number951148
License Number StateWI

VIII. Authorized Official

Name: MRS. DENISE RENEE BELLMORE
Title or Position: OWNER/MEMBER
Credential:
Phone: 920-434-8181