Provider Demographics
NPI:1356142947
Name:BEAUTIFUL LIFE DD SERVICES
Entity type:Organization
Organization Name:BEAUTIFUL LIFE DD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-709-6775
Mailing Address - Street 1:4205 S 96TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1260
Mailing Address - Country:US
Mailing Address - Phone:402-709-6775
Mailing Address - Fax:
Practice Address - Street 1:4205 S 96TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1260
Practice Address - Country:US
Practice Address - Phone:402-709-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUTIFUL LIFE ADULT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services