Provider Demographics
NPI:1255810628
Name:BLUE DRAGON HEALING CENTER
Entity type:Organization
Organization Name:BLUE DRAGON HEALING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:AP
Authorized Official - Phone:727-685-1390
Mailing Address - Street 1:4431 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3540
Mailing Address - Country:US
Mailing Address - Phone:727-685-1390
Mailing Address - Fax:727-685-1383
Practice Address - Street 1:4431 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3540
Practice Address - Country:US
Practice Address - Phone:727-685-1390
Practice Address - Fax:727-685-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3324261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821493321OtherINDIVIDUAL NPI