Provider Demographics
NPI:1083898639
Name:BEAUTIFUL LIFE ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:BEAUTIFUL LIFE ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-ADMINISTARTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-329-1025
Mailing Address - Street 1:1551 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4925
Mailing Address - Country:US
Mailing Address - Phone:662-329-1025
Mailing Address - Fax:
Practice Address - Street 1:1551 2ND AVE N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4925
Practice Address - Country:US
Practice Address - Phone:662-329-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08505823Medicaid