MEDICARE: BELLA BEAUTY AND HAIR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1104457217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA BEAUTY AND HAIR LLC

Provider Business Mailing Address
First Line	:	1436 85TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1416
Country	:	US
Telephone Number	:	763-710-4597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1436 85TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1416
Country	:	US
Telephone Number	:	763-710-4597
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	KAREN COFFEY
Credential	:
Telephone Number	:	612-600-5615

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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