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General NPI Number Information
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NPI Number | 1033484704
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Entity Type | Organization
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Legal Business Name | BELLA FAMILY HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 10555 E COUNTY ROAD 800N
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City | MATTOON
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State | IL
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Zip | 61938-3574
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Country | US
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Telephone | 217-235-4227
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Fax | 217-235-4274
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Provider Business Mailing Address
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Address Line | 907 W LINCOLN AVE
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City | CHARLESTON
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State | IL
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Zip | 61920-2413
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Country | US
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Telephone | 217-345-2100
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Fax | 217-345-8366
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Authorized Official
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Title or Position | PRESIDENT AND SOLE MEMBER
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Name | DR. ALDO CARMEN RUFFOLO
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Credential | D.O.
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Telephone | 217-345-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 248000561
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 248000561
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License Number State | IL
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