Provider Demographics
NPI:1508345661
Name:BELLA VIDA BMHA LLC
Entity Type:Organization
Organization Name:BELLA VIDA BMHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNYS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-427-5307
Mailing Address - Street 1:4550 W OAKEY BLVD STE 104A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1506
Mailing Address - Country:US
Mailing Address - Phone:702-427-5307
Mailing Address - Fax:
Practice Address - Street 1:4550 W OAKEY BLVD STE 104A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1506
Practice Address - Country:US
Practice Address - Phone:702-427-5307
Practice Address - Fax:702-920-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health