Provider Demographics
NPI:1316715758
Name:BEAUTIFUL LIFE ADULT CARE LLC
Entity type:Organization
Organization Name:BEAUTIFUL LIFE ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
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
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1221
Mailing Address - Country:US
Mailing Address - Phone:402-709-6775
Mailing Address - Fax:833-471-3392
Practice Address - Street 1:4205 S 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1221
Practice Address - Country:US
Practice Address - Phone:402-709-6775
Practice Address - Fax:833-471-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care