Organization
WILSON WELLNESS GROUP INC
Active
Other names
Bella Home Medical & Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY BALKIN (CEO)
(262) 657-3333
Entity
Organization
Contact information
Practice address
1836 E BELVIDERE RD, GRAYSLAKE, IL 60030-2289
(847) 548-1076
(847) 548-1071
Mailing address
1836 E BELVIDERE RD, GRAYSLAKE, IL 60030-2289
(847) 548-1076
(847) 548-1071
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5539340002
MEDICARE PTAN
IL
Enumeration date
08/18/2009
Last updated
03/12/2010
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