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General NPI Number Information
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NPI Number | 1356983027
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Entity Type | Organization
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Legal Business Name | BELLA VISTA CONTINUED CARE HOME
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 1435 BELLA VISTA DR
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City | COLUMBIA
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State | SC
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Zip | 29223-7201
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Country | US
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Telephone | 803-206-3098
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 PLATT SPRINGS ROAD #4283
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City | WEST COLUMBIA
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State | SC
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Zip | 29171
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Country | US
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Telephone | 803-206-3098
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GWENDOLYN ELAINE PETERSON
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Credential |
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Telephone | 803-206-3098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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