| Bob Belloni Ranch, Inc. | |
|
320 Central Ave Ste 406 Coos Bay OR 97420-2241 | |
| (541) 269-0321 | |
| Not Available |
| Full Name | Bob Belloni Ranch, Inc. |
|---|---|
| Speciality | Behavior Analyst |
| Location | 320 Central Ave Ste 406, Coos Bay, Oregon |
| Authorized Official Name and Position | Roger Langlie (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5412690321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bob Belloni Ranch, Inc. 320 Central Ave Ste 406 Coos Bay OR 97420-2241 Ph: (541) 269-0321 | Bob Belloni Ranch, Inc. 320 Central Ave Ste 406 Coos Bay OR 97420-2241 Ph: (541) 269-0321 |
| NPI Number | 1568899243 |
|---|---|
| Provider Enumeration Date | 09/26/2013 |
| Last Update Date | 09/26/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568899243 | NPI | - | NPPES |
| 500400418 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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