Provider Demographics
NPI:1114644283
Name:BEAUTIFUL LIFE INC.
Entity Type:Organization
Organization Name:BEAUTIFUL LIFE INC.
Other - Org Name:BEAUTIFUL LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LINNETTE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-491-1265
Mailing Address - Street 1:1380 E SILVERADO RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5924
Mailing Address - Country:US
Mailing Address - Phone:702-453-8878
Mailing Address - Fax:702-453-8874
Practice Address - Street 1:6252 EUGENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3311
Practice Address - Country:US
Practice Address - Phone:702-780-7543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250017812Medicaid