Healthcare Provider Details

I. General information

NPI: 1144992801
Provider Name (Legal Business Name): BEAUTIFUL LIFE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E SILVERADO RANCH BLVD
LAS VEGAS NV
89183-5924
US

IV. Provider business mailing address

1380 E SILVERADO RANCH BLVD
LAS VEGAS NV
89183-5924
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-8878
  • Fax: 702-453-8874
Mailing address:
  • Phone: 702-453-8878
  • Fax: 702-453-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CONNIE L HARRIS
Title or Position: PRESIDENT
Credential:
Phone: 702-491-1265