Provider Demographics
NPI:1275889412
Name:BELLA VITA HEALTHCARE
Entity Type:Organization
Organization Name:BELLA VITA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PURINTON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:928-649-7899
Mailing Address - Street 1:PO BOX 1851
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-1851
Mailing Address - Country:US
Mailing Address - Phone:928-649-7899
Mailing Address - Fax:928-649-7898
Practice Address - Street 1:294 W STATE ROUTE 89A STE 209
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3765
Practice Address - Country:US
Practice Address - Phone:928-649-7899
Practice Address - Fax:928-649-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14606207VX0000X
AZAP3450363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1972547867Medicare PIN
AZ1508190174Medicare PIN