Provider Demographics
NPI:1295305803
Name:BELLAROGOL, INC.
Entity type:Organization
Organization Name:BELLAROGOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-359-3751
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0792
Mailing Address - Country:US
Mailing Address - Phone:360-359-3751
Mailing Address - Fax:
Practice Address - Street 1:1508 4TH AVE E APT D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4518
Practice Address - Country:US
Practice Address - Phone:360-359-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare