Healthcare Provider Details

I. General information

NPI: 1033484704
Provider Name (Legal Business Name): BELLA FAMILY HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 E COUNTY ROAD 800N
MATTOON IL
61938-3574
US

IV. Provider business mailing address

907 W LINCOLN AVE
CHARLESTON IL
61920-2413
US

V. Phone/Fax

Practice location:
  • Phone: 217-235-4227
  • Fax: 217-235-4274
Mailing address:
  • Phone: 217-345-2100
  • Fax: 217-345-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248000561
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number248000561
License Number StateIL

VIII. Authorized Official

Name: DR. ALDO CARMEN RUFFOLO
Title or Position: PRESIDENT AND SOLE MEMBER
Credential: D.O.
Phone: 217-345-2100