Provider Demographics
NPI:1962411702
Name:BEL-REGIONAL HOME MEDICAL INC
Entity type:Organization
Organization Name:BEL-REGIONAL HOME MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CLINIC MAINTENANCE
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROOBANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-445-7222
Mailing Address - Street 1:595 COUNTY TRUNK R
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208
Mailing Address - Country:US
Mailing Address - Phone:920-433-3480
Mailing Address - Fax:
Practice Address - Street 1:595 COUNTY TRUNK R
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208
Practice Address - Country:US
Practice Address - Phone:920-433-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEL-REGIONAL HOME MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-07
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00077770423336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherTAX ID
WI=========OtherTAX ID