Healthcare Provider Details

I. General information

NPI: 1841882271
Provider Name (Legal Business Name): BEUTIFULL REMEDI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 GOLDSMITH LN STE 103
LOUISVILLE KY
40218-3096
US

IV. Provider business mailing address

1949 GOLDSMITH LN STE 103
LOUISVILLE KY
40218-3096
US

V. Phone/Fax

Practice location:
  • Phone: 502-830-9038
  • Fax:
Mailing address:
  • Phone: 502-830-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE SANDERS
Title or Position: BILLING MANAGER
Credential:
Phone: 502-630-2036