Provider Demographics
NPI:1700174760
Name:BEL-REGIONAL HOME MEDICAL INC
Entity Type:Organization
Organization Name:BEL-REGIONAL HOME MEDICAL INC
Other - Org Name:BELLIN HEALTH REMOTE DISPENSING
Other - Org Type:Other Name
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-431-5696
Mailing Address - Street 1:PO BOX 23400
Mailing Address - Street 2:744 S. WEBSTER AVE
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-3400
Mailing Address - Country:US
Mailing Address - Phone:920-431-5696
Mailing Address - Fax:920-431-5677
Practice Address - Street 1:555 QUALITY CT
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:WI
Practice Address - Zip Code:54180-9006
Practice Address - Country:US
Practice Address - Phone:920-532-0700
Practice Address - Fax:920-532-0728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEL-REGIONAL HOME MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8904-0423336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy