Provider Demographics
NPI:1033484704
Name:BELLA FAMILY HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BELLA FAMILY HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:RUFFOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-345-2100
Mailing Address - Street 1:907 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2413
Mailing Address - Country:US
Mailing Address - Phone:217-345-2100
Mailing Address - Fax:217-345-8366
Practice Address - Street 1:10555 E COUNTY ROAD 800N
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-3574
Practice Address - Country:US
Practice Address - Phone:217-235-4227
Practice Address - Fax:217-235-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL248000561207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty