Provider Demographics
NPI:1679667109
Name:BEL-REGIONAL HOME MEDICAL INC
Entity Type:Organization
Organization Name:BEL-REGIONAL HOME MEDICAL INC
Other - Org Name:BELLIN HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC/PROVIDER MAINTENANCE
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROOBANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-445-7222
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305
Mailing Address - Country:US
Mailing Address - Phone:920-431-5696
Mailing Address - Fax:920-431-5677
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54305
Practice Address - Country:US
Practice Address - Phone:920-431-5696
Practice Address - Fax:920-431-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7816-0423336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7816-042OtherSTATE LICENSE
WIBB6140014OtherDEA CERTIFICATE