Provider Demographics
NPI:1972275733
Name:BELLA TERRA STABLES
Entity Type:Organization
Organization Name:BELLA TERRA STABLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:ILSE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISELE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:240-305-7526
Mailing Address - Street 1:4913 LOGAN FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9724
Mailing Address - Country:US
Mailing Address - Phone:434-533-5545
Mailing Address - Fax:
Practice Address - Street 1:4913 LOGAN FERRY RD
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-9724
Practice Address - Country:US
Practice Address - Phone:434-533-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health