Provider Demographics
NPI:1275186835
Name:BELLA FAMILY HEALTHCARE & AESTHETICS
Entity Type:Organization
Organization Name:BELLA FAMILY HEALTHCARE & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-957-6871
Mailing Address - Street 1:1545 E LEIGHFIELD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5371
Mailing Address - Country:US
Mailing Address - Phone:208-957-6871
Mailing Address - Fax:208-957-6872
Practice Address - Street 1:1545 E LEIGHFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5371
Practice Address - Country:US
Practice Address - Phone:208-957-6871
Practice Address - Fax:208-957-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care