Provider Demographics
NPI:1578873006
Name:BEAUTIFUL ME
Entity Type:Organization
Organization Name:BEAUTIFUL ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-965-1119
Mailing Address - Street 1:PO BOX 823902
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:FL
Mailing Address - Zip Code:33082
Mailing Address - Country:US
Mailing Address - Phone:954-965-1119
Mailing Address - Fax:954-965-0119
Practice Address - Street 1:2301 N. UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-965-1119
Practice Address - Fax:954-965-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty