Provider Demographics
NPI:1053180349
Name:BELLA ROSE HEALTHCARE L.L.C.
Entity type:Organization
Organization Name:BELLA ROSE HEALTHCARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LTC ADMIN
Authorized Official - Phone:762-822-9567
Mailing Address - Street 1:7661 KAYNE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2546
Mailing Address - Country:US
Mailing Address - Phone:706-221-3520
Mailing Address - Fax:706-221-3522
Practice Address - Street 1:7661 KAYNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2546
Practice Address - Country:US
Practice Address - Phone:706-221-3520
Practice Address - Fax:706-221-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCH012233OtherDEPARTMENT OF COMMUNITY HEALTH