Provider Demographics
NPI:1568741767
Name:BELLA ROSE REHABILITATION & AQUATIC SERVICES LLC
Entity Type:Organization
Organization Name:BELLA ROSE REHABILITATION & AQUATIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEDERHOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:231-775-3081
Mailing Address - Street 1:1900 S LACHANCE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651
Mailing Address - Country:US
Mailing Address - Phone:231-775-3081
Mailing Address - Fax:231-775-7740
Practice Address - Street 1:1900 S LACHANCE RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8024
Practice Address - Country:US
Practice Address - Phone:231-775-3081
Practice Address - Fax:231-775-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty