MEDICARE: BELLAHOMECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1225879745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAHOMECARE LLC

Provider Business Mailing Address
First Line	:	629 GUAVA AVE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-5427
Country	:	US
Telephone Number	:	406-998-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 OLD RANCH RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-5011
Country	:	US
Telephone Number	:	406-998-8022
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHERRY T COOK
Credential	:
Telephone Number	:	406-998-8022

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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