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General NPI Number Information
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NPI Number | 1265860852
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Entity Type | Organization
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Legal Business Name | BELLA-BROOKE, LLC
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1115 2ND ST
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-2134
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Country | US
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Telephone | 660-646-1595
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Fax | 660-646-1595
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Provider Business Mailing Address
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Address Line | 1115 2ND ST
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-2134
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Country | US
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Telephone | 660-646-1595
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Fax | 660-646-1595
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Authorized Official
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Title or Position | OWNER/ HEALTHCARE CORDINATOR
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Name | MRS. DIANA LYNN DEARDORFF
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Credential | LPN
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Telephone | 660-646-1595
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 1137
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License Number State | MO
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