Provider Demographics
NPI:1083175913
Name:BELLA TREATMENT CENTER PC
Entity Type:Organization
Organization Name:BELLA TREATMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-231-6627
Mailing Address - Street 1:28763 NORTHWESTERN HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1842
Mailing Address - Country:US
Mailing Address - Phone:248-327-6888
Mailing Address - Fax:
Practice Address - Street 1:28763 NORTHWESTERN HWY STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1842
Practice Address - Country:US
Practice Address - Phone:248-327-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty