Provider Demographics
NPI:1245774074
Name:BELLARAE HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:BELLARAE HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-361-3399
Mailing Address - Street 1:784 CRYSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3317
Mailing Address - Country:US
Mailing Address - Phone:970-361-3399
Mailing Address - Fax:877-679-2777
Practice Address - Street 1:784 CRYSTAL WAY
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-3317
Practice Address - Country:US
Practice Address - Phone:970-361-3399
Practice Address - Fax:877-679-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04Z835251E00000X
CO04V336253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04V336OtherCOLORADO SUBLICENSE FOR IN-HOME SUPPORT SERVICES
CO04Z835OtherCOLORADO HOME CARE AGENCY CLASS-B NON-MEDICAL LICENSE