Provider Demographics
NPI:1497806681
Name:BELLEMEADE, INC
Entity Type:Organization
Organization Name:BELLEMEADE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULSOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-754-8294
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:MOUNT EDEN
Mailing Address - State:CA
Mailing Address - Zip Code:94557-0095
Mailing Address - Country:US
Mailing Address - Phone:510-754-8294
Mailing Address - Fax:510-537-1741
Practice Address - Street 1:29255 RUUS RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-6334
Practice Address - Country:US
Practice Address - Phone:510-754-8294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0200000419320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60559FOtherLTC PROVIDER NUMBER