Provider Demographics
NPI:1609493162
Name:BEAUTIFUL LIFE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:BEAUTIFUL LIFE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-707-1911
Mailing Address - Street 1:33 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2036
Mailing Address - Country:US
Mailing Address - Phone:917-674-5788
Mailing Address - Fax:718-569-6858
Practice Address - Street 1:135 N PLAINS INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2332
Practice Address - Country:US
Practice Address - Phone:203-707-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty