Provider Demographics
NPI:1063295897
Name:BADOLIAN ENTERPRISES, INC
Entity type:Organization
Organization Name:BADOLIAN ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:BADOLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:417-274-6234
Mailing Address - Street 1:6304 COUNTY ROAD 1820
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:MO
Mailing Address - Zip Code:65789-9171
Mailing Address - Country:US
Mailing Address - Phone:417-274-6234
Mailing Address - Fax:
Practice Address - Street 1:1622 PORTER WAGONER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1806
Practice Address - Country:US
Practice Address - Phone:417-274-6234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare