Healthcare Provider Details

I. General information

NPI: 1326607508
Provider Name (Legal Business Name): BEAUTIFUL LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
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: 702-491-1265
  • Fax: 702-453-8874
Mailing address:
  • Phone: 702-491-1265
  • Fax: 702-453-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CONNIE LINNETTE HARRIS
Title or Position: MANAGER
Credential:
Phone: 702-491-1265