Provider Demographics
NPI:1669485561
Name:BELLCOA HOME HEALTH SERVICE, INC
Entity Type:Organization
Organization Name:BELLCOA HOME HEALTH SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KOLAWOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLASUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-608-8292
Mailing Address - Street 1:7801 N. LAMAR BLVD
Mailing Address - Street 2:SUITE D-79
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1039
Mailing Address - Country:US
Mailing Address - Phone:512-533-9990
Mailing Address - Fax:512-533-9992
Practice Address - Street 1:7801 N. LAMAR BLVD
Practice Address - Street 2:SUITE D-79
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1039
Practice Address - Country:US
Practice Address - Phone:512-533-9990
Practice Address - Fax:512-533-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457871Medicare Oscar/Certification