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General NPI Number Information
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NPI Number | 1245774074
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Entity Type | Organization
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Legal Business Name | BELLARAE HOME CARE AGENCY, LLC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 784 CRYSTAL WAY
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City | FRUITA
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State | CO
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Zip | 81521-3317
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Country | US
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Telephone | 970-361-3399
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Fax | 877-679-2777
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Provider Business Mailing Address
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Address Line | 784 CRYSTAL WAY
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City | FRUITA
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State | CO
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Zip | 81521-3317
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Country | US
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Telephone | 970-361-3399
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Fax | 877-679-2777
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Authorized Official
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Title or Position | AGENCY MANAGER
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Name | JUAN GUARA
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Credential |
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Telephone | 970-361-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 04Z835
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 04V336
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License Number State | CO
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