Provider Demographics
NPI:1679729834
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:CLINIC PROVIDER CREDENTIALING
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 1:964 W RYAN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110
Mailing Address - Country:US
Mailing Address - Phone:920-756-3242
Mailing Address - Fax:
Practice Address - Street 1:964 W RYAN ST
Practice Address - Street 2:SUITE E
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110
Practice Address - Country:US
Practice Address - Phone:920-756-3242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38727100Medicaid
WI38727100Medicaid