Provider Demographics
NPI:1356169197
Name:BEAUTIFUL LIFE CHANGES
Entity type:Organization
Organization Name:BEAUTIFUL LIFE CHANGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAMONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-450-6778
Mailing Address - Street 1:11720 AMBER PARK DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2271
Mailing Address - Country:US
Mailing Address - Phone:314-404-4089
Mailing Address - Fax:
Practice Address - Street 1:11720 AMBER PARK DR STE 160
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2271
Practice Address - Country:US
Practice Address - Phone:404-408-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier