Provider Demographics
NPI:1902950504
Name:BELLOC CARE LLC
Entity Type:Organization
Organization Name:BELLOC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-847-5805
Mailing Address - Street 1:102 PARK PLACE BLVD
Mailing Address - Street 2:BUILDING D SUITE #1
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2358
Mailing Address - Country:US
Mailing Address - Phone:407-847-5805
Mailing Address - Fax:407-343-5804
Practice Address - Street 1:102 PARK PLACE BLVD
Practice Address - Street 2:BUILDING D SUITE# 1
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2358
Practice Address - Country:US
Practice Address - Phone:407-847-5805
Practice Address - Fax:407-343-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88797261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268371700Medicaid
FLK8625Medicare PIN