Provider Demographics
NPI:1538461959
Name:OPULENT LIVING INC
Entity Type:Organization
Organization Name:OPULENT LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-297-3424
Mailing Address - Street 1:8221 NW 54TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4965
Mailing Address - Country:US
Mailing Address - Phone:954-297-3424
Mailing Address - Fax:954-533-8528
Practice Address - Street 1:3971 NW 122ND TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3364
Practice Address - Country:US
Practice Address - Phone:954-297-3424
Practice Address - Fax:954-533-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688265096253Z00000X
FL688265098253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688265098Medicaid
FL688265096Medicaid