Provider Demographics
NPI:1043344146
Name:BELL THERAPY CSP
Entity Type:Organization
Organization Name:BELL THERAPY CSP
Other - Org Name:PHOENIX CARE SYSTEMS
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERILYN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:DE FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-564-0067
Mailing Address - Street 1:3324 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9704
Mailing Address - Country:US
Mailing Address - Phone:262-552-7311
Mailing Address - Fax:
Practice Address - Street 1:5500 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3700
Practice Address - Country:US
Practice Address - Phone:262-564-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148570030163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty